Wentzer, Helle; Bygholm, Ann
of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure....... These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. Results: This paper...... develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT. Conclusion and discussion: The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences...
Most health care transformation efforts are unsuccessful because they overlook the importance of personal transformation in enabling major systemic change. Personal transformation is about creating access to a broader range of ways of being, thinking, and acting in order to be more effective in dealing with those challenges for which conventional strategies are inadequate. As many of the changes that are taking place in health care are inevitable, mastering context is critical to transformation. In moving the organization forward, key thought leaders who embrace new ways of working together can help others recontextualize their challenges, thereby serving as important catalysts for diffusing these innovations into the culture. The ensuing improvement in performance is less the result of having learned some new concept or theory and more a function of having altered the context through which one's challenges are understood. When individual transformation parallels organizational transformation, a tipping point is reached where there is a visible increase in organizational members' effectiveness, a marked increase in organizational members' impact on others' performance, and a collective experience that work is more fulfilling.
The general health insurance introduced in Poland in 1999 is essentially a social insurance. In this article, the main features of the present health care system are discussed, i.e. the sources and principles of financing, ownership relations, structures, entitlements to obtain medical services and the rules of access to services. Emphasis has been put on the operations of various entities operating within the health care sector, including opportunistic conduct of the providers of services financed from public sources, cost dumping, establishing provider alliances, methods of cost control, and the fact that some patients leave the publicly financed system. In Poland, a parallel private system has been developing for many years. Systemic transformations have not changed that direction, but increased considerably the significance of household income and education as the factors that differentiate patient in equality. This article is concluded with the note on the opportunities for the development of supplementary private insurance.
Steaban, Robin Lea
This article is meant to spur debate on the role of the professional nurse in care coordination as well as the role of nursing leaders for defining and leading to a future state. This work highlights the opportunity and benefits associated with transformation of professional nursing practice in response to the mandates of the Affordable Care Act of 2010. An understanding of core concepts and the work of care coordination are used to propose a model of care coordination based on the population health pyramid. This maximizes the roles of nurses across the continuum as transformational leaders in the patient/family and nursing relationship. The author explores the role of the nurse in a transactional versus transformational relationship with patients, leading to actualization of the nurse in care coordination. Focusing on the role of the nurse leader, the challenges and necessary actions for optimization of the professional nurse role are explored, using principles of transformational leadership.
global relevance, as for example the Chronic Disease Self-Management Program, which has been adopted by countries as diverse as Japan, Australia and Denmark. But how does this happen and which effects does traveling have on a health care program and its place of arrival? This question is the starting......Plenty of policies, politics and programs preoccupied with the health of the worker, the patient, the children, the old or society at large are being launched. The success of these programs is related to their geographical spread. If a health care program does not leave the desk where it first saw...... light, its chances of influencing those it would like bear down on is bound to be minimal. For a health care program to have an effect it must be able to travel or move between practices. Some health care programs successfully accomplish this task. They come to be widely adopted, apparently having...
light, its chances of influencing those it would like bear down on is bound to be minimal. For a health care program to have an effect it must be able to travel or move between practices. Some health care programs successfully accomplish this task. They come to be widely adopted, apparently having...... global relevance, as for example the Chronic Disease Self-Management Program, which has been adopted by countries as diverse as Japan, Australia and Denmark. But how does this happen and which effects does traveling have on a health care program and its place of arrival? This question is the starting...
Beebe, Lora Humphrey; Roman, Marian; Raynor, Hollie; Thompson, Dixie; Ray, Shaunta
We provide an overview of the Recovery-based Interprofessional Distance Education (RIDE) rotation for graduate students in psychiatric mental health (PMH) nursing, pharmacy, nutrition, and exercise physiology, with faculty from the four professions represented. Interprofessional education can enhance team concepts in these professions and is viewed positively by students and faculty. Interprofessional learning opportunities prepare graduates to contribute to team-based care. We urge colleagues to join us in providing meaningful IPE experiences to students at all levels, with the goal of optimizing health care for all persons with mental health treatment needs. © 2016 Wiley Periodicals, Inc.
Rao, Shaline; Brammer, Craig; McKethan, Aaron; Buntin, Melinda B
Adoption of health information technology (HIT) is a key effort in improving care delivery, reducing costs of health care, and improving the quality of health care. Evidence from electronic health record (EHR) use suggests that HIT will play a significant role in transforming primary care practices and chronic disease management. This article shows that EHRs and HIT can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety. Copyright © 2012 Elsevier Inc. All rights reserved.
Lukas, Carol VanDeusen; Holmes, Sally K; Cohen, Alan B; Restuccia, Joseph; Cramer, Irene E; Shwartz, Michael; Charns, Martin P
The Institute of Medicine's 2001 report Crossing the Quality Chasm argued for fundamental redesign of the U.S. health care system. Six years later, many health care organizations have embraced the report's goals, but few have succeeded in making the substantial transformations needed to achieve those aims. This article offers a model for moving organizations from short-term, isolated performance improvements to sustained, reliable, organization-wide, and evidence-based improvements in patient care. Longitudinal comparative case studies were conducted in 12 health care systems using a mixed-methods evaluation design based on semistructured interviews and document review. Participating health care systems included seven systems funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and five systems with long-standing commitments to improvement and high-quality care. Five interactive elements appear critical to successful transformation of patient care: (1) Impetus to transform; (2) Leadership commitment to quality; (3) Improvement initiatives that actively engage staff in meaningful problem solving; (4) Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization; and (5) Integration to bridge traditional intra-organizational boundaries among individual components. These elements drive change by affecting the components of the complex health care organization in which they operate: (1) Mission, vision, and strategies that set its direction and priorities; (2) Culture that reflects its informal values and norms; (3) Operational functions and processes that embody the work done in patient care; and (4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization. The conceptual model holds promise for guiding health care
In psychiatry in Denmark health and social care is being replaced by diagnostic categorisations and a more consumerized relation between the health professionals and patients as self- responsible citizens. Increasing medicalization and New Public Management reforms and standardization for cost......- effectiveness intertwine with a neo-liberal health policy of a “user- focus and user involvement”,that transforms psychiatric practice. Through the micro-sociological study of professionals working with patients in psychiatry, it is illuminated how patients/clients are objectified and left to care...... for themselves, and how professionalism is transformed into manualisation of practice, and test technologies replace meeting “significant others”....
Clement, D G; Wan, T T
The effective health services executive needs to continue to develop analytical, technical and behavioral skills to anticipate and meet the changing requirements of the health care industry. Those leading the field of health administration will need to be competent in achieving transformations. Lifelong learning is a necessity. As the structure and knowledge of the field change, so must the ways of exchanging information about health and medical care. Distance learning is a strategy for lifelong learning that can be used to continue one's education. In order to be successful in positioning a health care organization in the competitive world, investment in continued education to update strategic thinking and the analytical competency of executives and managers is imperative. Academic programs able to respond to the educational needs of the health care industry have a dedicated faculty who understand corporate culture and competitiveness in the health care marketplace and are able to offer effective adult education using cutting-edge computer technology for distance learning.
This article explores some of the latest developments of the emergence of Caring Science as the moral, theoretical, and philosophical foundation for nursing, leading to transformative personal/professional practices. Through nurse's taking responsibility for advancing nursing qua nursing, practitioners, patients, and systems alike are witnessing a revolution in nursing, which is restoring the heart of nursing and health care through theory-guided philosophical practices of heart-centered love and caring as the foundation for healing.
Huynh, Ho Phi; Sweeny, Kate; Miller, Tricia
Clinicians face the complex challenge of motivating their patients to achieve optimal health while also ensuring their satisfaction. Inspired by transformational leadership theory, we proposed that clinicians' motivational behaviors can be organized into three patient care styles (transformational, transactional, and passive-avoidant) and that these styles differentially predict patient health outcomes. In two studies using patient-reported data and observer ratings, we found that transformational patient care style positively predicted patients' satisfaction and health expectations above and beyond transactional and passive-avoidant patient care style. These findings provide initial support for the patient care style approach and suggest novel directions for the study of clinicians' motivational behaviors.
Best, Allan; Greenhalgh, Trisha; Lewis, Steven; Saul, Jessie E; Carroll, Simon; Bitz, Jennifer
An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait lists. The aims of the review were to analyze examples of successful and less successful transformation initiatives, to synthesize knowledge of the underlying mechanisms, to clarify the role of government, and to outline options for evaluation. We used realist review, whose working assumption is that a particular intervention triggers particular mechanisms of change. Mechanisms may be more or less effective in producing their intended outcomes, depending on their interaction with various contextual factors. We explain the variations in outcome as the interplay between context and mechanisms. We nested this analytic approach in a macro framing of complex adaptive systems (CAS). Our rapid realist review identified five "simple rules" of LST that were likely to enhance the success of the target initiatives: (1) blend designated leadership with distributed leadership; (2) establish feedback loops; (3) attend to history; (4) engage physicians; and (5) include patients and families. These principles play out differently in different contexts affecting human behavior (and thereby contributing to change) through a wide range of different mechanisms. Realist review methodology can be applied in combination with a complex system lens on published literature to produce a knowledge synthesis that informs a prospective change effort in large-system transformation. A collaborative process engaging both research producers and research users contributes to local applications of universal principles and
Full Text Available In order to be the health care system sustainable , management transformations must be based on very precise diagnostic analysis that includes complete and current information. It is necessary to implement an information system that collects information in real time, that watches the parameters that significantly influence the sustainability of the system. Such an information system should point out a radiography(a scan of the system at some time under following aspects:: 1. An overview of system; 2 An overview of the economic situation; 3 A technical presentation ;4. A legal overview; 5. A social overview ; 6. A management overview .Based on these Xrays of the health system, it outlines a series of conclusions and recommendations together with a SWOT analysis that highlights the potential internal (strengths and weaknesses and external potential (opportunities and threats. Based on this analysis and recommendations, the management is going to redesign the system in order to be adapted to the changing environmental requirements. Management transformation is recommended to be by following steps. :1. The development of a new management system that would make a positive change in the health care system 2. Implementation of the new management system 3. Assessment of the changes
Lee, Shoou-Yih Daniel; Weiner, Bryan J; Harrison, Michael I; Belden, C Michael
Health care organization leaders and policy makers seeking ways to reform the delivery of health care have become increasingly interested in transformational change. To foster understanding of how organizational transformation occurs and to stimulate further research, we report findings from a systematic review of empirical research on transformational change in the health care and non-health care literature, with a focus on the antecedents, processes (or paths), and outcomes of transformational change. Fifty-six studies, of which 13 were in health care, met our selection criteria. With one exception, all were published since 1990, indicating the recent upsurge of interest in this area. Limited differences were found between health care and non-health care studies. Available research documents the multiplicity of factors affecting change and the complexity of their interactions, but less information is available about the processes of transformational change than about its antecedents and consequences. Research and practice implications are discussed.
Kirch, Darrell G; Ast, Cori E
The health care system of the United States has been in a period of dramatic transformation since the passage of the Affordable Care Act in 2010, and the rate of change is accelerating. Historically, health care delivery was focused on the efforts of independent individual providers related to single patients, but the future will require interprofessional teamwork to achieve successful transformation. Academic health centers must identify nimble leaders who can harness the expertise of every team member to succeed in yielding the triple aim-better care for individuals, better health for populations, and lower overall cost. To create this change, there are several critical success factors for academic health center leaders, including creating a culture of collaboration, becoming "multipliers," embracing innovation, adhering to core professional ethics, and working to promote resilience. Given their extensive training and predisposition to these skills, psychologists are well-positioned to serve as leaders in today's academic health systems.
Compagni, Amelia; Manderscheid, Ronald W
The field of mental health has long suffered from a lack of convergence of disciplines that deal with the mind, the brain, and behavior. This mind-brain dualism has been particularly detrimental for consumers and their families who daily face stigma and discrimination. The understanding of the brain and its dysfunctions has benefited from the study of the human genome and, in particular, of the mutations and variations in its code. This analysis permits a better understanding of the biological basis of mental disease and will soon inform a generation of new diagnostic tools and individualized pharmacological therapies. A biological perspective on mental illness will be complemented by the analysis of the social factors influencing people's behavior and their impact on brain biology and gene function. Neurobiology has progressed to a level for which the knowledge that is generated, even if still colored with uncertainty, could represent a catalyst for the creation of an alliance between neuroscientists and consumers. This partnership has the potential to benefit both parties but will require some concrete steps that might be outside of the usual courses of action for both consumers and scientists. It is by building collaborations based on personal contact and information sharing that a transformation of the mental health care system can occur.
McDonagh, Kathryn J; Paris, Nancy M
Women have had a transformative influence on the health care field as highly effective leaders known to produce superior results. Women make up the vast majority of the health care workforce as well as health care graduates. Women also make most health care decisions on behalf of their families. Yet, despite this omnipresence in health care, there is a dearth of women in chief executive and governance roles. A lack of leadership development and succession planning in health care and other obstacles to career progression make it challenging for women to advance to top leadership levels. The traditional linear career ladder that has existed in health care is not conducive to women's advancement. Women have taken a different pathway to career development referred to as the leadership labyrinth. This is a development process leading to wisdom and insights essential for today's health care challenges. This crucial stage in the evolution of health care calls for new models of care and leadership. The most abundant resource at risk of being overlooked is the optimal engagement of women. Women leaders are the backbone of the health care workforce but have yet to be strategically deployed in key leadership positions. The talents of women leaders can be a significant factor in the transformation of health care.
Sands, D Z; Wald, J S
Address current topics in consumer health informatics. Literature review. Current health care delivery systems need to be more effective in the management of chronic conditions as the population turns older and experiences escalating chronic illness that threatens to consume more health care resources than countries can afford. Most health care systems are positioned poorly to accommodate this. Meanwhile, the availability of ever more powerful and cheaper information and communication technology, both for professionals and consumers, has raised the capacity to gather and process information, communicate more effectively, and monitor the quality of care processes. Adapting health care systems to serve current and future needs requires new streams of data to enable better self-management, improve shared decision making, and provide more virtual care. Changes in reimbursement for health care services, increased adoption of relevant technologies, patient engagement, and calls for data transparency raise the importance of patient-generated health information, remote monitoring, non-visit based care, and other innovative care approaches that foster more frequent contact with patients and better management of chronic conditions.
Bauer, J C; Brown, W T
Health care is being changed dramatically by the marriage of computers and telecommunications. Implications for hospitals and physicians already have received extensive media attention, but comparatively little has been said about the impact of information technology on dentistry. This article illustrates how the digital transformation will likely affect dentists and their patients. Based on recent experiences of hospitals and medical practices, dentists can expect to encounter revolutionary changes as a result of the digital transformation. The Internet, the World Wide Web and other developments of the information revolution will redefine patient care, referral relationships, practice management, quality, professional organizations and competition. To respond proactively to the digital transformation of oral health care, dentists must become familiar with its technologies and concepts. They must learn what new information technology can do for them and their patients and then develop creative applications that promote the profession and their approaches to care.
Full Text Available The transformation of health services in South Africa today is governed by the political, policy and legislative frameworks. This article focuses on the transformation of a primary health care service within a local authority in Gauteng. The purpose with this article is to explore and describe the perceptions (expectations and fears of selected managers employed in this primary health care service. The results are utilised to compile a strategy (framework for transformation management and leadership within the primary health care service. A qualitative research design was utilised and the data was collected by means of individual interviews with selected managers in the service, followed by a content analysis. The expectations and fears of managers focus mainly on personnel matters, community participation/satisfaction, salaries and parity, inadequate stocks/supplies and medication, the deterioration of quality service delivery and the need for training and empowerment. These results are divided into structure, process and outcome dimensions and are embodied in the conceptual framework for the transformation and leadership strategy. It is recommended that standards for transformation management be formulated and that the quality of transformation management be evaluated accordingly.
Schwamm, Lee H
"Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.
Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti
Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients' homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs' work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) (p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs' job is feasible and can effectively promote HCAs' health, especially among older HCAs.
Full Text Available Home care aides (HCAs, predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients’ homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs’ work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise (p = 0.027. Almost all (98% HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs’ job is feasible and can effectively promote HCAs’ health, especially among older HCAs.
Partridge, Edward E.; Pisu, Maria; Martin, Michelle Y.; Demark-Wahnefried, Wendy; Acemgil, Aras; Kenzik, Kelly; Kvale, Elizabeth A.; Meneses, Karen; Li, Xuelin; Li, Yufeng; Halilova, Karina I.; Jackson, Bradford E.; Chambless, Carol; Lisovicz, Nedra; Fouad, Mona; Taylor, Richard A.
The Patient Care Connect Program (PCCP) is a lay patient navigation program, implemented by the University of Alabama at Birmingham Health System Cancer Community Network. The PCCP’s goal is to provide better health and health care, as well as to lower overall expenditures. The program focuses on enhancing the health of patients, with emphasis on patient empowerment and promoting proactive participation in health care. Navigator training emphasizes palliative care principles and includes development of skills to facilitate advance care planning conversations. Lay navigators are integrated into the health care team, with the support of a nurse supervisor, physician medical director, and administrative champion. The intervention focuses on patients with high needs to reach those with the greatest potential for benefit from supportive services. Navigator activities are guided by frequent distress assessments, which help to identify patient concerns across multiple domains, triage patients to appropriate resources, and ultimately overcome barriers to health care. In this article, we describe the PCCP’s development, infrastructure, selection and training of lay navigators, and program operations. PMID:27165489
Rissi, Jill Jamison; Gelmon, Sherril; Saulino, Evan; Merrithew, Nicole; Baker, Robin; Hatcher, Paige
Health system reform is largely dependent upon the transformation of primary care in addition to the alignment of incentives that mediate the allocation of resources. The Patient-Centered Medical Home (PCMH) is a model of enhanced primary care that encourages coordination, patient-centered care, integration of public health services, and innovative methods for improving population health-all critical elements of health system reform. Because it changes the way primary care is organized and delivered, the PCMH model has been adopted as a foundational component of Oregon's health system transformation. This article presents insights drawn from an evaluation of the implementation of Oregon's Patient-Centered Primary Care Home (PCPCH) program and the adoption of the model by primary care providers. We used a mixed-methods approach consisting of 2 surveys of recognized PCPCH practices, qualitative document analysis, and key informant interviews. Evaluation research findings were triangulated with findings from PCPCH clinic site visits conducted as part of a regulatory verification process. Survey results describe a broad range of strategies and practices adopted by recognized PCPCH clinics within 6 defined core attributes: (1) access to care; (2) accountability; (3) comprehensive whole-person care; (4) continuity; (5) coordination and integration; and (6) person- and family-centered care. We also identify 4 key factors that influenced the conceptualization, development, and implementation of the PCPCH program: (1) support and motivations; (2) administrative barriers and resource constraints; (3) alignment of short- and long-term financial incentives; and (4) leadership and interpersonal relationships. This evaluation provides insights into the factors that influence implementation of a primary care home program as public policy; the strategies and challenges associated with implementation of the model; and the implications of both for other states that are engaged in
Rich, Josiah D.; Chandler, Redonna; Williams, Brie A.; Dumont, Dora; Wang, Emily A.; Taxman, Faye S.; Allen, Scott A.; Clarke, Jennifer G.; Greifinger, Robert B.; Wildeman, Christopher; Osher, Fred C.; Rosenberg, Steven; Haney, Craig; Mauer, Marc; Western, Bruce
Provisions of the Affordable Care Act offer new opportunities to apply a public health and medical perspective to the complex relationship between involvement in the criminal justice system and the existence of fundamental health disparities. Incarceration can cause harm to individual and community health, but prisons and jails also hold enormous potential to play an active and beneficial role in the health care system and, ultimately, to improving health. Traditionally, incarcerated populations have been incorrectly viewed as isolated and self-contained communities with only peripheral importance to the public health at large. This misconception has resulted in missed opportunities to positively affect the health of both the individuals and the imprisoned community as a whole and potentially to mitigate risk behaviors that may contribute to incarceration. Both community and correctional health care professionals can capitalize on these opportunities by working together to advocate for the health of the criminal justice–involved population and their communities. We present a set of recommendations for the improvement of both correctional health care, such as improving systems of external oversight and quality management, and access to community-based care, including establishing strategies for postrelease care and medical record transfers. PMID:24590946
Rich, Josiah D; Chandler, Redonna; Williams, Brie A; Dumont, Dora; Wang, Emily A; Taxman, Faye S; Allen, Scott A; Clarke, Jennifer G; Greifinger, Robert B; Wildeman, Christopher; Osher, Fred C; Rosenberg, Steven; Haney, Craig; Mauer, Marc; Western, Bruce
Provisions of the Affordable Care Act offer new opportunities to apply a public health and medical perspective to the complex relationship between involvement in the criminal justice system and the existence of fundamental health disparities. Incarceration can cause harm to individual and community health, but prisons and jails also hold enormous potential to play an active and beneficial role in the health care system and, ultimately, to improving health. Traditionally, incarcerated populations have been incorrectly viewed as isolated and self-contained communities with only peripheral importance to the public health at large. This misconception has resulted in missed opportunities to positively affect the health of both the individuals and the imprisoned community as a whole and potentially to mitigate risk behaviors that may contribute to incarceration. Both community and correctional health care professionals can capitalize on these opportunities by working together to advocate for the health of the criminal justice-involved population and their communities. We present a set of recommendations for the improvement of both correctional health care, such as improving systems of external oversight and quality management, and access to community-based care, including establishing strategies for postrelease care and medical record transfers.
Full Text Available Abstract Background Integrated personal health records (PHRs offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable. Discussion While there is a spectrum of dominant PHR models, (standalone, tethered, integrated, the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders. Summary Integrated PHRs
Huff, Wynelle J.; Bancarz, Gloria P.
In 2002, Adventist Health(West) embarked upon a major project to better serve its communities by enhancing the safety, quality and clinical outcomes of the patients served by its 20 hospitals, i.e. the transformation of patient care through the use of information technology. The project is the implementation of the Cerner Millenium clinical information system (CIS) entitled Project IntelliCare. Budgeted allocations will go toward the training of 'super users' in 5-7 California Sites scheduled for installation and go-live of Phases I and II in 2005 and early 2006. Numerous super users in each hospital must be educated to provide support for every shift, every unit/department throughout the hospital. The hospitals experience significant costs associated with training these super users to thoroughly understand the CIS software, to train clinical users, to support the 'go-live' installations, and be there as a 'cheerleader to encourage and support all clinical users, and most importantly help guide users to transform their work processes using this information technology to provide the safest, highest quality care possible. Indeed, super users are critical to the success of Project IntelliCare. The 'super users' contributed significantly to the success of the 'go-live' impementations as well as ongoing support. Care has been transformed through clinicians use of information technology.
The future of healthcare technologies, and what they mean for investors and entrepreneurs The healthcare technology revolution is just around the corner. And when it arrives, it will change and enrich our lives in ways we can only begin to imagine. Doctors will perform blood pressure readings via video chat and nutritionists will analyze diet based on photos taken with cellphone cameras. Transforming Health Care combines healthcare, technology, and finance in an innovative new way that explains the future of healthcare and its effects on patient care, exploring the emergence of electronic tools that will transform the medical industry. Explaining how technology, not politics, will lead the future of the healthcare revolution, author and healthcare technology expert Phil Fasano presents real-life examples that show how the next generation of medical breakthroughs will come from the instant exchange of information across the world Explores how new technologies will radically change the future of healthcare by m...
Schwartz, Richard W; Tumblin, Thomas F
Physician leadership is emerging as a vital component in transforming the nation's health care industry. Because few physicians have been introduced to the large body of literature on leadership and organizations, we herein provide a concise review, as this literature relates to competitive health care organizations and the leaders who serve them. Although the US health care industry has transitioned to a dynamic market economy governed by a wide range of internal and external forces, health care organizations continue to be dominated by leaders who practice an outmoded transactional style of leadership and by organizational hierarchies that are inherently stagnant. In contrast, outside the health care sector, service industries have repeatedly demonstrated that transformational, situational, and servant leadership styles are most successful in energizing human resources within organizations. This optimization of intellectual capital is further enhanced by transforming organizations into adaptable learning organizations where traditional institutional hierarchies are flattened and efforts to evoke change are typically team driven and mission oriented.
Scott, Kathy A; Pringle, Janice
Health care leaders are responsible for oversight of multiple and competing change interventions. These interventions regularly fail to achieve the desired outcomes and/or sustainable results. This often occurs because of the mental models and approaches that are used to plan, design, implement, and evaluate the system. These do not account for inherent characteristics that determine the system's likely ability to innovate while maintaining operational effectiveness. Theories exist on how to assess a system's readiness to change, but the definitions, constructs, and assessments are diverse and often look at facets of systems in isolation. The Systems Transformation Framework prescriptively defines and characterizes system domains on the basis of complex adaptive systems theory so that domains can be assessed in tandem. As a result, strengths and challenges to implementation are recognized before implementation begins. The Systems Transformation Framework defines 8 major domains: vision, leadership, organizational culture, organizational behavior, organizational structure, performance measurements, internal learning, and external learning. Each domain has principles that are critical for creating the conditions that lead to successful organizational adaptation and change. The Systems Transformation Framework can serve as a guide for health care leaders at all levels of the organization to (1) create environments that are change ready and (2) plan, design, implement, and evaluate change within complex adaptive systems.
Gilmartin, M J
Market transformations occurring within the health care industry require new patterns of organization and management to meet the increasing complexity of service delivery. A greater understanding of the innovation and entrepreneurial dynamic allows administrators, managers, and leaders to create a new vision of service delivery. Central management and leadership objectives include the development of service technologies that capitalize upon the inherent knowledge of workers to meet consumer needs. A strong sense of innovation and entrepreneurship leading to the introduction of new or improved nursing technologies is a primary component in the evolution of professional nursing practice for the 21st century.
Lavoie-Tremblay, Mélanie; Aubry, Monique; Cyr, Guylaine; Richer, Marie-Claire; Fortin-Verreault, Jean-François; Fortin, Claude; Marchionni, Caroline
To explore the characteristics that influence project management offices acceptance and adoption in healthcare sector. The creation of project management offices has been suggested as a promising avenue to promote successful organisational change and facilitate evidence-based practice. However, little is known about the characteristics that promote their initial adoption and acceptance in health care sector. This knowledge is important in the context where many organisations are considering implementing project management offices with nurse managers as leaders. A descriptive multiple case study design was used. The unit of analysis was the project management offices. The study was conducted in three university-affiliated teaching hospitals in 2013-14 (Canada). Individual interviews (n = 34) were conducted with senior managers. Results reveal that project management offices dedicated to project and change management constitute an innovation and an added value that addresses tangible needs in the field. Project management offices are an innovation highly compatible with health care managers and their approach has parallels to the process of clinical problem solving and reasoning well-known to adopters. This knowledge is important in a context where many nurses hold various roles in project management offices, such as Director, project manager, clinical expert and knowledge broker. © 2017 John Wiley & Sons Ltd.
Reza Soroushmehr, S M; Najarian, Kayvan
Health care systems generate a huge volume of different types of data. Due to the complexity and challenges inherent in studying medical information, it is not yet possible to create a comprehensive model capable of considering all the aspects of health care systems. There are different points of view regarding what the most efficient approaches toward utilization of this data would be. In this paper, we describe the potential role of big data approaches in improving health care systems and review the most common challenges facing the utilization of health care big data.
Full Text Available Martine C Lévesque,1,2 Richard Bruce Hovey,2,3 Christophe Bedos2,4 1Faculté de médecine, Université de Montréal, Montréal, QC, Canada; 2Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada; 3Faculty of Medicine, University of Calgary, Calgary, AB, Canada; 4Département de médecine sociale et préventive, Faculté de médicine, Université de Montréal, Montréal, QC, Canada Abstract: Following a historical brief on the development of patient-centered care (PCC, we discuss PCC's value and role in counterbalancing the evidence-based movement in health care. We in turn make a case for a philosophical shift in thinking about the PCC concept, one based on a consideration for how knowledge is produced, used, and valued within care provision processes. A “shared epistemology” foundation is presented, defined, and promoted as essential to the authentic and ethical realization of “shared decision making” between patient and health care provider, and, more generally, of PCC. In accordance with these views, this article critically reviews the literature on health care professional education for the development of PCC. We uncover the disturbing ways in which education frequently undermines the development of patient centeredness, despite curricular emphasis on professionalism and ethical PCC. We also establish the need to raise awareness of how dominant approaches to evaluating student or practitioner performance often fail to reinforce or promote patient centeredness. Finally, we identify successful and inspiring cases of teaching and learning experiences that have achieved perspective transformation on PCC and on new ways of providing care. The pertinence of adopting the theoretical foundations of adult transformative learning is argued, and a call to action is proposed to the leadership of health professional educators across all disciplines. Keywords: patient-centered care, health professional
McGrath, Katherine M; Bennett, Denise M; Ben-Tovim, David I; Boyages, Steven C; Lyons, Nigel J; O'Connell, Tony J
*Clinical process redesign has enabled significant improvements in the delivery of health care services in emergency departments and elective surgery programs in New South Wales and at Flinders Medical Centre in South Australia, with tangible benefits for patients and staff. *The principles used in clinical process redesign are not new; they have been applied in other industries with significant gains for many years, but have only recently been introduced into health care systems. *Through experience with clinical process redesign, we have learnt much about the factors critical to the success of implementing and sustaining this process in the health care setting. *The key elements for success are leadership by senior executives, clinical leadership, team-based problem solving, a focus on the patient journey, access to data, ambitious targets, strong performance management, and a process for maintaining improvement.
Mossialos, Elias; Courtin, Emilie; Naci, Huseyin; Benrimoj, Shalom; Bouvy, Marcel; Farris, Karen; Noyce, Peter; Sketris, Ingrid
Community pharmacists are the third largest healthcare professional group in the world after physicians and nurses. Despite their considerable training, community pharmacists are the only health professionals who are not primarily rewarded for delivering health care and hence are under-utilized as public health professionals. An emerging consensus among academics, professional organizations, and policymakers is that community pharmacists, who work outside of hospital settings, should adopt an expanded role in order to contribute to the safe, effective, and efficient use of drugs-particularly when caring for people with multiple chronic conditions. Community pharmacists could help to improve health by reducing drug-related adverse events and promoting better medication adherence, which in turn may help in reducing unnecessary provider visits, hospitalizations, and readmissions while strengthening integrated primary care delivery across the health system. This paper reviews recent strategies to expand the role of community pharmacists in Australia, Canada, England, the Netherlands, Scotland, and the United States. The developments achieved or under way in these countries carry lessons for policymakers world-wide, where progress thus far in expanding the role of community pharmacists has been more limited. Future policies should focus on effectively integrating community pharmacists into primary care; developing a shared vision for different levels of pharmacist services; and devising new incentive mechanisms for improving quality and outcomes. Copyright © 2015. Published by Elsevier Ireland Ltd.
Mastellos, N.; Andreasson, A.; Curcin, V.; Verheij, R.; Hek, K.; Car, J.; Delaney, B.
Background: Opportunistic recruitment to clinical studies is a particularly demanding process for GPs, patients and researchers. To date, this is performed manually using paper-based administration methods. The EU FP7-funded TRANSFoRm project team is currently finalising the tools to enable
Full Text Available The implementation of health technology and informatics into healthcare environments has enabled new opportunities for developing patient-centred approaches to care. The emergence of mobile learning as a new pedagogy for learning and teaching of undergraduate nurses and for continuing professional development can be used to strengthen the nurse-patient relationship. Incorporation of eHealth literacy education and health promotion by nurses, using digital technology tools and resources, will assist with empowering patients to access information and options for managing their own health. These developments provide opportunities for embracing a learning triad with patient, student, and nurse supervisor using digital technology at point of care. This triad should be embedded as a partnership to enable promotion of eHealth literacy in situ. A use case scenario is provided to demonstrate the potential of advancing eHealth literacy of patients in healthcare environments using the triad model. Collaboration and sharing information using this new method of learning has the potential to promote eHealth literacy and transform the nurse-patient relationship.
Kuperberg, Karen; Mager, Diana; Dello, Susan
Patient food service is an important component in the nutritional management of hospitalized children. The previous meal delivery system at The Hospital for Sick Children in Toronto was a cold-plating re-thermalized system. Issues related to this model included order lead time, the reheating process, menu selection, and service style. Research into other systems led us toward room service, an innovative and flexible mode of meal delivery. Transformation to room service occurred over one year, and included implementation of a new computer system, kitchen renovation, redesign of menus and a new meal delivery system called Meal Train, and changes to human resource allocations. Throughout the transformation, consultations were held with key stakeholders, including the children's council, the family advisory, the nursing council, and a multidisciplinary committee involving nursing staff, dietitians, patient service aides, infection control personnel, occupational health employees, patient representatives, and food services staff. Now, Meal Train is running smoothly, and meal days and food costs have been reduced. Others considering a project like this must know their clients' needs and be willing to think outside the box. They should familiarize themselves with current information on systems and equipment, consult with key stakeholders within their organization, and then create the system that will work for them.
Murray, Bethany A
This study examined the experiences of nursing students following a service-learning placement in Swaziland. Students worked in a hospital and implemented community health clinics. Six students were interviewed 1 month after their return from the overseas study experience. A thematic analysis was performed. Four themes emerged. The first theme was transitions-students experienced personal hardships, emotional reactions, and language difficulties that created discomfort. The second theme was perceptions-cultural dissonance was encountered between the health care and nursing cultures of Swaziland and the United States. The third theme was internalization-discomfort and cultural dissonance activated coping mechanisms within students that generated a process of change in attitudes and beliefs. The fourth theme was incorporation-personal and professional growth were demonstrated with greater awareness, compassion, resourcefulness, and comfort with diversity. The stress and cultural dissonance experienced by students led to an increase in cultural understanding and awareness. Copyright 2015, SLACK Incorporated.
Westra, Bonnie L; Latimer, Gail E; Matney, Susan A; Park, Jung In; Sensmeier, Joyce; Simpson, Roy L; Swanson, Mary Jo; Warren, Judith J; Delaney, Connie W
There is wide recognition that, with the rapid implementation of electronic health records (EHRs), large data sets are available for research. However, essential standardized nursing data are seldom integrated into EHRs and clinical data repositories. There are many diverse activities that exist to implement standardized nursing languages in EHRs; however, these activities are not coordinated, resulting in duplicate efforts rather than building a shared learning environment and resources. The purpose of this paper is to describe the historical context of nursing terminologies, challenges to the use of nursing data for purposes other than documentation of care, and a national action plan for implementing and using sharable and comparable nursing data for quality reporting and translational research. In 2013 and 2014, the University of Minnesota School of Nursing hosted a diverse group of nurses to participate in the Nursing Knowledge: Big Data and Science to Transform Health Care consensus conferences. This consensus conference was held to develop a national action plan and harmonize existing and new efforts of multiple individuals and organizations to expedite integration of standardized nursing data within EHRs and ensure their availability in clinical data repositories for secondary use. This harmonization will address the implementation of standardized nursing terminologies and subsequent access to and use of clinical nursing data. Foundational to integrating nursing data into clinical data repositories for big data and science, is the implementation of standardized nursing terminologies, common data models, and information structures within EHRs. The 2014 National Action Plan for Sharable and Comparable Nursing Data for Transforming Health and Healthcare builds on and leverages existing, but separate long standing efforts of many individuals and organizations. The plan is action focused, with accountability for coordinating and tracking progress designated
Vázquez-Calatayud, Mónica; Oroviogoicoechea, Cristina; Saracibar, Maribel; Pumar-Méndez, María J
Although the concept of 'Transforming care' is promising for improving health care, there is no consensus in the field as to its definition. The aim of this concept analysis is to develop a deeper understanding of the term 'Transforming care' within the nursing discipline, in order to facilitate its comprehension, implementation, and evaluation. We performed a comprehensive literature review on electronic databases such as Medline (PubMed), Cinahl (Ebsco), Cochrane Library, PsycINFO (Ovid), Web of Science, Wiley-Blackwell, ScienceDirect, and SpringerLink and used Walker and Avant's approach to analyse the concept. From the 20 studies selected for this analysis, 3 main attributes of 'Transforming care' were identified: patient-centredness, evidence-based change, and transformational leadership driven. We suggest an operational definition to facilitate the implementation of the concept in practice. Furthermore, we propose that implementation is guided by the following key ideas: (1) fostering a culture of continuous improvement; (2) encouraging bottom-up initiatives; (3) promoting patient-centred care; and (4) using transformational leadership. Lastly, the evaluation of 'Transforming care' initiatives should assess care processes and professionals' and patients' outcomes.
Tanner, Christine A
The Carnegie Foundation for the Advancement of Teaching joins a chorus of calls for transformation of prelicensure nursing education (Benner, Sutphen, Leonard, & Day, 2009). Citing the shift of significant responsibility to nurses for managing complex medical regimens, as well as the increasing complexity of community-based practices, Benner and colleagues concluded that nurses entering the field are not equipped with the essential knowledge and skills for today's practice nor prepared to continue learning for tomorrow's nursing (p. 31). They found: a) weak curricula in natural sciences, technology, social sciences, and humanities, and in developing cultural competency; b) weak classroom instruction and limited integration between classroom and clinical experiences; c) limited strategies in helping students develop habits of inquiry, raising clinical questions, seeking evidence for practices; d) faculty and student perception that students are ill prepared for their first job and dissatisfaction with the teaching preparation of current nursing faculty; and e) multiple pathways to eligibility for the licensure examination, with tremendous variability in prerequisites, curricular requirements, and the quality of offerings.
Unhjem, Jeanette Varpen; Vatne, Solfrid; Hem, Marit Helene
To describe what and why nurses self-disclose to patients in mental health care. Self-disclosure is common, but controversial and difficult to delineate. Extant research suggests that self-disclosure might have several potentially beneficial effects on therapeutic alliance and treatment outcome for patients in mental health care, but results are often mixed and limited by definitional inconsistencies. Qualitative descriptive study including data from 16 nurses taking part in participant observation, individual interviews and focus group interviews. Separate analyses resulted in four themes addressing the research question of what nurses self-disclose, and one main theme and four subthemes addressing why nurses self-disclose. The content of self-disclosure was captured in the four themes: Immediate family, Interests and activities, Life experiences, and Identity. In addition, results showed that disclosures were common among the nurses. Self-disclosure's potential to transform the nurse-patient relationship, making it more open, honest, close, reciprocal and equal, was the overarching reason why nurses shared personal information. The nurses also chose to self-disclose to share existential and everyday sentiments, to give real-life advice, because it felt natural and responsive to patients' question to do so. Nurse self-disclosure is common and covers a variety of personal information. Nurses have several reasons for choosing to self-disclose, most of which are connected to improving the nurse-patient relationship. Self-disclosure controversy can make it difficult for nurses to know if they should share personal information or not. Insights into the diversity of and reasons for nurse self-disclosure can help with deliberations on self-disclosure. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Examines regulatory trends and their impact on mHealth innovations and applications Offers solutions for those in the health care industry that are attempting to engage consumers in reducing healthcare costs and in improving their health care encounters and personal health Explains what is necessary for long-term viability of mHealth as a health care delivery medium.
Munir, Fehmidah; Nielsen, Karina; Garde, Anne H; Albertsen, Karen; Carneiro, Isabella G
To explore the mediating effects of work-life conflict between transformational leadership and job satisfaction and psychological wellbeing. The importance of work-life balance for job satisfaction and wellbeing among health-care employees is well-recognized. Evidence shows that transformational leadership style is linked to psychological wellbeing. It is possible that transformational leadership is also associated with employees' perceptions of work-life conflict, thereby influencing their job satisfaction and wellbeing. A longitudinal design was used where staff working within Danish elderly care completed a questionnaire at baseline and 18-month follow-up (N=188). Regression analyses showed that transformational leadership style was directly associated with perceptions of work-life conflict, job satisfaction and psychological wellbeing. Work-life conflict mediated between transformational leadership and wellbeing, but not job satisfaction. The findings suggest transformational leadership style may improve perceptions of work-life balance and employee wellbeing. Managers should adopt transformational leadership styles to reduce work-life conflict and enhance the wellbeing of their staff. © 2011 Blackwell Publishing Ltd.
Siegel, Corey A
Health care is changing rapidly, so we must change with the times to develop more efficient, practical, cost-effective, and, importantly, high-quality methods to care for patients. We teach medical students that optimal patient care requires face-to-face interaction to collect information on the patient's history and perform the physical examination. However, management of many patients-especially those with chronic diseases-does not always require physical examination. Telemedicine offers an opportunity to take advantage of technology while leveraging the progressive push toward efficiency and value but also requires the belief that excellent patient care is not always provided in person. Telemedicine can include a variety of aspects of patient care adapted to be performed remotely, such as telemonitoring, tele-education, teleconsultation, and telecare. All of these have been evaluated in gastroenterology practice and have demonstrated feasibility and patient preference but have produced mixed results regarding patient outcomes. By combining telemedicine tools and new care models, we can redesign chronic disease management to include fewer in-person visits when patients are well yet increase access for patients who need to be seen. This change could lead to higher-value care by improving the experience of care, decreasing costs, and improving the health of the population. Barriers include reimbursement, licensing, and fear of litigation. However, if we hope to meet the needs of patients within our changing health care system, telemedicine should be incorporated into our strategy. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.
Mattke, Soeren; Liu, Hangsheng; Hunter, Lauren E; Gu, Kun; Newberry, Sydne
After having successfully expanded health insurance coverage, China now faces the challenge of building an effective and efficient delivery system to serve its large and aging population. The country finds itself at a crossroads-it can emulate the models of Western countries with their well-known limitations, or embark on an ambitious endeavor to create an innovative and sustainable model. We recommend that China choose the second option and design and implement a health care system based on population health management principles and sophisticated health information technology. Taking this path could yield a triple dividend for China: Health care will contribute to the growth of service sector employment, stimulate domestic demand by unlocking savings, and enable China to export its health system development capabilities to other emerging economies, mirroring its success in building other critical infrastructure. These forces can help turn the Chinese Dream into a reality.
Moe, Jeffrey L; Pappas, Gregory; Murray, Andrew
Background Following the demise of Jordan's King Hussein bin Talal to cancer in 1999, the country's Al-Amal Center was transformed from a poorly perceived and ineffectual cancer care institution into a Western-style comprehensive cancer center. Renamed King Hussein Cancer Center (KHCC), it achieved improved levels of quality, expanded cancer care services and achieved Joint Commission International accreditation under new leadership over a three-year period (2002–2005). Methods An exploratory case research method was used to explain the rapid change to international standards. Sources including personal interviews, document review and on-site observations were combined to conduct a robust examination of KHCC's rapid changes. Results The changes which occurred at the KHCC during its formation and leading up to its Joint Commission International (JCI) accreditation can be understood within the conceptual frame of the transformational leadership model. Interviewees and other sources for the case study suggest the use of inspirational motivation, idealized influence, individualized consideration and intellectual stimulation, four factors in the transformational leadership model, had significant impact upon the attitudes and motivation of staff within KHCC. Changes in the institution were achieved through increased motivation and positive attitudes toward the use of JCI continuous improvement processes as well as increased professional training. The case study suggests the role of culture and political sensitivity needs re-definition and expansion within the transformational leadership model to adequately explain leadership in the context of globalizing health care services, specifically when governments are involved in the change initiative. Conclusion The KHCC case underscores the utility of the transformational leadership model in an international health care context. To understand leadership in globalizing health care services, KHCC suggests culture is broader
Full Text Available Abstract Background Following the demise of Jordan's King Hussein bin Talal to cancer in 1999, the country's Al-Amal Center was transformed from a poorly perceived and ineffectual cancer care institution into a Western-style comprehensive cancer center. Renamed King Hussein Cancer Center (KHCC, it achieved improved levels of quality, expanded cancer care services and achieved Joint Commission International accreditation under new leadership over a three-year period (2002–2005. Methods An exploratory case research method was used to explain the rapid change to international standards. Sources including personal interviews, document review and on-site observations were combined to conduct a robust examination of KHCC's rapid changes. Results The changes which occurred at the KHCC during its formation and leading up to its Joint Commission International (JCI accreditation can be understood within the conceptual frame of the transformational leadership model. Interviewees and other sources for the case study suggest the use of inspirational motivation, idealized influence, individualized consideration and intellectual stimulation, four factors in the transformational leadership model, had significant impact upon the attitudes and motivation of staff within KHCC. Changes in the institution were achieved through increased motivation and positive attitudes toward the use of JCI continuous improvement processes as well as increased professional training. The case study suggests the role of culture and political sensitivity needs re-definition and expansion within the transformational leadership model to adequately explain leadership in the context of globalizing health care services, specifically when governments are involved in the change initiative. Conclusion The KHCC case underscores the utility of the transformational leadership model in an international health care context. To understand leadership in globalizing health care services, KHCC
Moe, Jeffrey L; Pappas, Gregory; Murray, Andrew
Following the demise of Jordan's King Hussein bin Talal to cancer in 1999, the country's Al-Amal Center was transformed from a poorly perceived and ineffectual cancer care institution into a Western-style comprehensive cancer center. Renamed King Hussein Cancer Center (KHCC), it achieved improved levels of quality, expanded cancer care services and achieved Joint Commission International accreditation under new leadership over a three-year period (2002-2005). An exploratory case research method was used to explain the rapid change to international standards. Sources including personal interviews, document review and on-site observations were combined to conduct a robust examination of KHCC's rapid changes. The changes which occurred at the KHCC during its formation and leading up to its Joint Commission International (JCI) accreditation can be understood within the conceptual frame of the transformational leadership model. Interviewees and other sources for the case study suggest the use of inspirational motivation, idealized influence, individualized consideration and intellectual stimulation, four factors in the transformational leadership model, had significant impact upon the attitudes and motivation of staff within KHCC. Changes in the institution were achieved through increased motivation and positive attitudes toward the use of JCI continuous improvement processes as well as increased professional training. The case study suggests the role of culture and political sensitivity needs re-definition and expansion within the transformational leadership model to adequately explain leadership in the context of globalizing health care services, specifically when governments are involved in the change initiative. The KHCC case underscores the utility of the transformational leadership model in an international health care context. To understand leadership in globalizing health care services, KHCC suggests culture is broader than organizational or societal culture to
Gowen, Charles R; Henagan, Stephanie C; McFadden, Kathleen L
The health care industry has become one of the largest sectors of the U.S. economy and provides the greatest job growth of any industry. With such growth, effective leadership, knowledge management, and quality programs can ameliorate patient safety outcomes and improve organizational performance. This exploratory study examines the efficacy of transformational leadership, knowledge management, and quality initiatives, each of which has been proven effective in health care organizations. The literature has neglected the relationships among these three types of programs, although they are increasingly implemented simultaneously now. This research tests the degree to which knowledge management could act as a mediator of the effects transformational leadership and quality management have on organizational performance for hospitals. Our survey of U.S. hospitals utilizes validated scales from the literature. By calling and e-mailing quality and other department directors, the data set includes responses from all 50 states in our sample of 370 U.S. hospitals. Statistical tests confirmed acceptable regional distribution, interrater reliability, and control variable characteristics for our sample. Structural equation modeling is used to test the research hypotheses. These preliminary results reveal that transformational leadership and quality management improve knowledge management. In addition, transformational leadership is fully mediated by knowledge responsiveness and quality management is partially mediated by knowledge responsiveness for their effects on organizational performance. The unique contribution of this study includes the suggestion that greater transformational leadership skills are important for health care executives to motivate successful knowledge management initiatives. Secondly, continuous improvements in quality management programs have significant positive impacts on knowledge management and organizational outcomes in hospitals. Finally, successful
This dissertation adds to the literature on how institutions of care transform. It shows how differently positioned actors, including people with HIV, their friends and families, local health providers and officials, policy makers, local and international NGOs, bilateral, multilateral and
Ravitz, Paula; Wondimagegn, Dawit; Pain, Clare; Araya, Mesfin; Alem, Atalay; Baheretibeb, Yonas; Hanlon, Charlotte; Fekadu, Abebaw; Park, Jamie; Fefergrad, Mark; Leszcz, Molyn
Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treating mental disorders mostly lie dormant in consensus-treatment guidelines. Broadly disseminating these psychotherapies by training trainers and front-line health workers could close the gap between mental health needs and access to care. Research in continuing medical education and knowledge translation can inform the design of educational interventions to build capacity for providing psychotherapy to those who need it. This paper summarizes psychotherapy training recommendations that: adapt treatments to cultural and health organizational contexts; consider implementation barriers, including opportunity costs and mental health stigma; and engage local opinion leaders to use longitudinal, interactive, case-based teaching with reflection, skills-coaching, simulations, auditing and feedback. Community-based training projects in Northern Ontario, Canada and Ethiopia illustrate how best-education practices can be implemented to disseminate evidence-supported psychotherapies, such as IPT, to expand the therapeutic repertoire of health care workers and improve their patients' clinical outcomes.
Hoge, Charles W; Ivany, Christopher G; Brusher, Edward A; Brown, Millard D; Shero, John C; Adler, Amy B; Warner, Christopher H; Orman, David T
The cumulative strain of 14 years of war on service members, veterans, and their families, together with continuing global threats and the unique stresses of military service, are likely to be felt for years to come. Scientific as well as political factors have influenced how the military has addressed the mental health needs resulting from these wars. Two important differences between mental health care delivered during the Iraq and Afghanistan wars and previous wars are the degree to which research has directly informed care and the consolidated management of services. The U.S. Army Medical Command implemented programmatic changes to ensure delivery of high-quality standardized mental health services, including centralized workload management; consolidation of psychiatry, psychology, psychiatric nursing, and social work services under integrated behavioral health departments; creation of satellite mental health clinics embedded within brigade work areas; incorporation of mental health providers into primary care; routine mental health screening throughout soldiers' careers; standardization of clinical outcome measures; and improved services for family members. This transformation has been accompanied by reduction in psychiatric hospitalizations and improved continuity of care. Challenges remain, however, including continued underutilization of services by those most in need, problems with treatment of substance use disorders, overuse of opioid medications, concerns with the structure of care for chronic postdeployment (including postconcussion) symptoms, and ongoing questions concerning the causes of historically high suicide rates, efficacy of resilience training initiatives, and research priorities. It is critical to ensure that remaining gaps are addressed and that knowledge gained during these wars is retained and further evolved.
DiSesa, Verdi J; Kaiser, Larry R
Academic medical centers (AMCs) and the physicians and other professionals who lead them need to recognize they are in a business that is making a transition from a system of "sickness" care to one of "health" care, accountable for the health of defined populations and for the value (quality divided by cost) of the services provided. This change has profound implications for how AMCs conceive themselves, how they function, and how they are paid for the work that they do. A failure to recognize how the disruption of the mission of AMCs is changing may impair them as irrevocably as other changes caused the demise of Kodak, once the world's leader in the manufacture and sale of photographic film and cameras. Leaders of academic medicine need to understand, respond to, and ultimately lead the transformation of our system of health. In this Commentary, the authors review the pressures driving these changes and potential responses to them-a process already under way. They summarize the issues in the question "Should the words 'health' and 'system' take the place of 'medical' and 'center' in our institutions' names and, more important, in how we conceive of what we do?" The authors propose the name "academic health system" to better identify primary objectives to measure success by the health of patients.
Park, Melissa M; Lencucha, Raphael; Mattingly, Cheryl; Zafran, Hiba; Kirmayer, Laurence J
The Mental Health Commission of Canada worked collaboratively with stakeholders to create a new framework for a federal mental health strategy, which is now mandated for implementation by 2017. The proposed strategies have been written into provincial health plans, hospital accreditation standards, and the annual objectives of psychiatric departments and community organizations. This project will explore the decision-making process among those who contributed to Canada's first federal mental health policy and those implementing this policy in the clinical setting. Despite the centrality of ethical reasoning to the successful uptake of the recent national guidelines for recovery-oriented care, to date, there are no studies focused exclusively on the ethical tensions that emerged and continue to emerge during the creation and implementation of the new standards for recovery-oriented practice. This two-year Canadian Institute of Health Research Catalyst Grant in Ethics (2015-2017) consists of three components. C-I, a retrospective, qualitative study consisting of document analysis and interviews with key policy-makers of the ethical tensions that arose during the development of Canada's Mental Health Strategy will be conducted in parallel to C-II, a theory-based, focused ethnography of how mental health practitioners in a psychiatric setting reason about and act upon new standards in everyday practice. Case-based scenarios of ethical tensions will be developed from C-I/II and fed-forward to C-III: participatory forums with policy-makers, mental health practitioners, and other stakeholders in recovery-oriented services to collectively identify and prioritize key ethical concerns and generate action steps to close the gap between the policy-making process and its implementation at the local level. Policy-makers and clinicians make important everyday decisions that effect the creation and implementation of new practice standards. Particularly, there is a need to
... available at a drop-in clinic. Some large companies provide access to virtual doctors' offices as a ... https://www.niddk.nih.gov/health-information/health-communication-programs/ndep/health-care-professionals/practice-transformation/information- ...
vaccine for their children. journal of. COMMUNITY HEALTH. & PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26(2) 46-58. Correspondence to: Ijadunola M.Y. Department of Community Health, Faculty of Clinical Sciences,. College of Health Sciences, Obafemi Awolowo University,.
M.Cur. (Nursing Management) Transformational leadership involves the creation of a motivating climate that enhances growth, development, commitment, goal achievement and enjoyment which encourages behaviour based on a set of shared values (Price, 2006:124). In this study transformational leadership referred to concepts of motivation, and change management with regard to the implementation of the Cervical Cancer Screening Programme in a PRe setting. During support visits in Ekurhuleni Healt...
Huynh, Ho P; Sweeny, Kate
A key role of clinicians is to motivate their patients to initiate and maintain beneficial health behaviors. This article integrates research on transformational leadership, clinician-patient communication, and health behavior to introduce a novel approach to understanding and improving clinicians' effectiveness as motivators. We describe three dominant clinician styles or patterned approaches to patient care that derive from leadership theory (in order of least to most effective): laissez-faire, transactional, and transformational. Additionally, we suggest potential mediators and effects of the transformational style of care. Finally, we discuss future research directions for the study of clinician styles of care. © The Author(s) 2013.
COMMUNITY HEALTH. & PRIMARY HEALTH CARE. KEYWORDS ABSTRACT. Correspondence to: Journal of Community Medicine and Primary Health Care. 26 (2) 1-6. Facility User's Preference between the Free and the Bamako. Initiative (Drug Revolving Fund-Based) Health Services in Iwajowa Local Government, Oyo ...
Rubasinghege, G. R. S.; Rijal, H.; Gurung, R.; Maldonado-Torres, S.; Rogelj, S.; Piyasena, M.
The growing medical and personal needs of the human population have escalated release of pharmaceuticals and personal care products (PPCPs) to the nature. The current work investigated abiotic degradation pathways of selected PPCPs in the presence of major mineral components of soil and the acute health effects of degraded PPCPs. Degradation of selected PPCPs (ibuprofen and clofibric acid) was carried out using custom-built glass reactors in batch studies. The secondary products of PPCPs were analyzed and identified using modified HPLC and LC-MS methods. Results from these studies showed that the extent of degradation depends on the type of the clay or mineral oxide, and solar radiation. In the absence of solar radiation (night time chemistry), the dominant reaction mechanism was observed to be the adsorption of PPCPs on to clay particles where surface functional groups and particle size play a key role. In contrast, under solar radiation, PPCPs break down to several fractions in the presence of clay particles. The decay rates were at least 3-fold higher for irradiated samples compared to that of dark conditions. Acute toxicity of selected PPCPs and their degradation products were tested on three microorganisms: gram-positive soil bacteria, Bacillus megaterium; gram-negative marine bacteria, Pseudoaltermonas atlantica; and algae from the Chlorella genus. Growth inhibition was measured using optical density measurements, MTT viability assay, and flow cytometer. The results suggest that the concentrations of primary compounds, Ibuprofen and Clofibric Acid, found in the environment that ranges from μg/L to ng/L are not sufficient to inhibit growth of either three microorganisms. However, selected organisms showed significant differences in sensitivity to degraded products. Results from current work advance our knowledge and understanding in the fields of environmental toxicology, chemistry in aqueous phases, and geochemistry.
Carter, M.W.; Hans, Elias W.; Kolisch, R.
Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully
healthcare providers in south-east Nigerian. Malaria. National population commission and ORC Macro. Journal.2009;8:22. 6. Amaghionyeodiwe LA. Determinants of the. 15. World Health Organisation. The African choice of health care provider in Nigeria. Health malaria report 2003. Available at. Care Management Science.
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This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.
Bulger, R J
As prefigured in the Greek tragedy Antigone, one of the primary conflicts in contemporary health care is that between humane concern for the individual and concern for society at large and administrative rules. The computerization of the health care system and development of large data bases will create new forms of this conflict that will challenge the self-definition of health care and health care professionals.
Shrank, William H
Americans are increasingly demanding the same level of service in healthcare that they receive in other services and products that they buy. This rise in consumerism poses challenges for primary care physicians as they attempt to transform their practices to succeed in a value-based reimbursement landscape, where they are rewarded for managing costs and improving the health of populations. In this paper, three examples of consumer-riven trends are described: retail healthcare, direct and concierge care, and home-based diagnostics and care. For each, the intersection of consumer-driven care and the goals of value-based primary care are explored. If the correct payment and connectivity enablers are in place, some examples of consumer-driven care are well-positioned to support primary care physicians in their mission to deliver high-quality, efficient care for the populations they serve. However, concerns about access and equity make other trends less consistent with that mission.
debut (20.8%), 40.8% had multiple sexual partners, 23.3% had sex under the influence of alcohol while. 34.2% didn't use ... PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26(2) 97-106. KEYWORDS. Risky sexual behaviour, young people, ..... 2010;15(1): Art. #505[cited consistent with ...
Up to 11 (7.2%) respondents in the non-BI LGA were not satisfied with the drug services in the health centers, compared ... improvement in primary health care services,. 8 ..... Naves J O, Silver LD. Evaluation of pharmaceutical assistance in public primary care in Brasilia, Brazil. Rev. Saude Publica. 2005; 39(2): 223-30. 21.
Snowdon, Anne W
Global health systems are challenged by escalating costs and growing demands for care created by the demands of aging populations and rising rates of chronic illness which place unsustainable pressure on health systems to meet population health needs. To overcome these challenges, transformational change is needed to strengthen health system performance and sustainability. Innovation is widely viewed as the strategy to drive transformational change in health systems; yet to date, innovation has lacked a clearly defined focus or agenda to achieve transformation. An actionable innovation agenda is needed to achieve transformational change for health systems. The key conditions for success as an innovation strategy are examined, including clearly defined innovation objectives, key milestones, and actionable steps every system stakeholder must pursue in order to guide the innovation agenda and ultimately accelerate the transformational changes needed for a sustainable healthcare system that delivers value to populations.
Younger, David S
China has recently emerged as an important global partner. However, like other developing nations, China has experienced dramatic demographic and epidemiologic changes in the past few decades. Population discontent with the health care system has led to major reforms. China's distinctive health care system, including its unique history, vast infrastructure, the speed of health reform, and economic capacity to make important advances in health care, nonetheless, has incomplete insurance coverage for urban and rural dwellers, uneven access, mixed quality of health care, increasing costs, and risk of catastrophic health expenditures. Copyright © 2016 Elsevier Inc. All rights reserved.
Younger, David S
Although a stated right for all Indians, equal access to health care in India is impeded by socioeconomic barriers. With its 3-tier system of public health care centers in villages, district hospitals, and tertiary care hospitals, government expenditure in India is inordinately low, with a disproportionate emphasis on private health spending. Accordingly, the poorest receive a minority of the available subsidies, whereas the richest obtain more than a third, fostering a divide in health care infrastructure across the rich and poor in urban and rural settings. This paradigm has implications for domestic Indian public health and global public health. Copyright © 2016 Elsevier Inc. All rights reserved.
... Caregivers Questions to Ask about Advanced Cancer Research Managing Cancer Care Finding Health Care Services Costs & Medical ... Feelings Planning for Advanced Cancer Advanced Cancer & Caregivers Managing Cancer Care Finding Health Care Services Managing Costs ...
Weatherly, Lisa M; Gosse, Julie A
Triclosan (TCS) is an antimicrobial used so ubiquitously that 75% of the US population is likely exposed to this compound via consumer goods and personal care products. In September 2016, TCS was banned from soap products following the risk assessment by the US Food and Drug Administration (FDA). However, TCS still remains, at high concentrations, in other personal care products such as toothpaste, mouthwash, hand sanitizer, and surgical soaps. TCS is readily absorbed into human skin and oral mucosa and found in various human tissues and fluids. The aim of this review was to describe TCS exposure routes and levels as well as metabolism and transformation processes. The burgeoning literature on human health effects associated with TCS exposure, such as reproductive problems, was also summarized.
... medicines or supplements that you are taking WHY PREVENTIVE HEALTH CARE IS IMPORTANT Even if you feel ... want to schedule a visit . Another part of preventive health is learning to recognize changes in your ...
Williams, Katherine M; Kirsh, Susan; Aron, David; Au, David; Helfrich, Christian; Lambert-Kerzner, Anne; Lowery, Julie; Battaglia, Catherine; Graham, Glenn D; Doukas, Michael; Jain, Rajiv; Ho, P Michael
Veteran's Affairs Office of Specialty Care (OSC) launched four national initiatives (Electronic-Consults [e-Consults], Specialty Care Access Networks-Extension for Community Healthcare Outcomes [SCAN-ECHO], Mini-Residencies, and Specialty Care Neighborhood) to improve specialty care delivery and funded a center to evaluate the initiatives. The evaluation, guided by two implementation frameworks, provides formative (administrator/provider interviews and surveys) and summative data (quantitative data on patterns of use) about the initiatives to OSC. Evaluation of initiative implementation is assessed through CFIR (Consolidated Framework for Implementation Research)-grounded qualitative interviews to identify barriers/facilitators. Depending on high or low implementation, factors such as receiving workload credit, protected time, existing workflow/systems compatibility, leadership engagement, and access to information/resources were considered implementation barriers or facilitators. Findings were shared with OSC and used to further refine implementation at additional sites. Evaluation of other initiatives is ongoing. The mixed-methods approach has provided timely information to OSC about initiative effect and impacted OSC policies on implementation at additional sites.
Early detection and treatment of these morbidities could prevent deterioration. The aim of the survey was to determine and compare the prevalence of ..... interventions. Increasing the detection rate of mental morbidity in the community is fundamental. The inclusion of mental health care as a component of primary health ...
large extent can reduce financial barriers to options; including government budgetary health care access ..... managers and demand-side factors, such as. International Health Conference. New adverse selection in ... patients in the scheme, and patient demand for. Information Centre. 1995. insured services. Many previous ...
With the recent passage of the National Defense Authorization Act for Fiscal Year 2017, Congress has triggered groundbreaking Military Health System organizational restructuring with the Defense Health Agency assuming responsibility for managing all hospitals and clinics owned by the Army, Navy, and Air Force. This is a major shift toward a modern value-based managed care system, which will require much greater military-civilian health care delivery integration to be in place by October 2018. Just before the National Defense Authorization Act for Fiscal Year 2017 passage, the Department of Defense had already begun a seismic shift and awarded a contract for the new Military Health System-wide electronic health record system. In this perspective, we discuss the implications of the intersection of two large-scope and large-scale initiatives, health system transformation, and information technology modernization, being rolled out in the largest and most complex federal agency and potential risk mitigating steps. The Military Health System will require an expanded unified clinical leadership to spearhead short-term transformation; furthermore, developing, organizing, and growing a cadre of informatics expertise to expand the use and diffusion of novel solutions such as health information exchanges, data analytics, and others to transcend organizational barriers are still needed to achieve the long-term aim of health system reform as envisioned by the National Defense Authorization Act for Fiscal Year 2017. © Association of Military Surgeons of the United States 2018. All rights reserved. For permissions, please e-mail: email@example.com.
Dearmon, Valorie; Roussel, Linda; Buckner, Ellen B; Mulekar, Madhuri; Pomrenke, Becky; Salas, Sheri; Mosley, Aimee; Brown, Stephanie; Brown, Ann
The purpose of this study was to examine the effectiveness of a Transforming Care at the Bedside initiative from a unit perspective. Improving patient outcomes and nurses' work environments are the goals of Transforming Care at the Bedside. Transforming Care at the Bedside creates programs of change originating at the point of care and directly promoting engagement of nurses to transform work processes and quality of care on medical-surgical units. This descriptive comparative study draws on multiple data sources from two nursing units: a Transforming Care at the Bedside unit where staff tested, adopted and implemented improvement ideas, and a control unit where staff continued traditional practices. Change theory provided the framework for the study. Direct care and value-added care increased on Transforming Care at the Bedside unit compared with the control unit. Transforming Care at the Bedside unit decreased in incidental overtime. Nurses reported that the process challenged old ways of thinking and increased nursing innovations. Hourly rounding, bedside reporting and the use of pain boards were seen as positive innovations. Evidence supported the value-added dimension of the Transforming Care at the Bedside process at the unit level. Nurses recognized the significance of their input into processes of change. Transformational leadership and frontline projects provide a vehicle for innovation through application of human capital. © 2012 Blackwell Publishing Ltd.
... map [a-z] More VA More VA Health Health Care Information A-Z Health Topic Finder My Health ... General QUICK LIST Apply for Benefits Apply for Health Care Prescriptions My Health e Vet eBenefits Life Insurance ...
Piper, Llewellyn E
The Patient Protection and Affordable Care Act will require health care leaders and managers to develop strategies and implement organizational tactics for their organization to survive and thrive under the federal mandates of this new health care law. Successful health care organizations and health care systems will be defined by their adaptability in the new value-based marketplace created by the Affordable Care Act. The most critical underlining challenge for this success will be the effective transformation of the organizational culture. Transformational value-based leadership is now needed to answer the ethical call for transforming the organizational culture. This article provides a model and recommendations to influence change in the most difficult leadership duty-transforming the organizational culture.
Boatright, Anne C
In this month's Magnet® Perspectives column, Anne Boatright, MSN, RN, SANE, describes her efforts to develop a comprehensive forensic nursing program at Methodist Hospital in Omaha. Ms Boatright transformed a sexual assault nurse examiner (SANE) program into one that provides 24/7 coverage at Methodist's 2 SANE locations and cares not only for victims of sexual assault but also for the victims domestic violence, sex trafficking, strangulation, elder abuse, and neglect. Her work extends beyond the walls of Methodist to the community, where she serves as a core member of the Nebraska Human Trafficking Task Force. She works collaboratively with the Federal Bureau of Investigation and helped Nebraska state senators draft legislation to create a sexual assault payment program. In recognition of her determination to make a difference for victims of violence, she received the 2016 National Magnet Nurse of the Year Award for Transformational Leadership.
Merlino, James I; Raman, Ananth
The Cleveland Clinic has long had a reputation for medical excellence. But in 2009 the CEO acknowledged that patients did not think much of their experience there and decided to act. Since then the Clinic has leaped to the top tier of patient-satisfaction surveys, and it now draws hospital executives from around the world who want to study its practices. The Clinic's journey also holds Lessons for organizations outside health care that must suddenly compete by creating a superior customer experience. The authors, one of whom was critical to steering the hospital's transformation, detail the processes that allowed the Clinic to excel at patient satisfaction without jeopardizing its traditional strengths. Hospital leaders: Publicized the problem internally. Seeing the hospital's dismal service scores shocked employees into recognizing that serious flaws existed. Worked to understand patients' needs. Management commissioned studies to get at the root causes of dissatisfaction. Made everyone a caregiver. An enterprisewide program trained everyone, from physicians to janitors, to put the patient first. Increased employee engagement. The Clinic instituted a "caregiver celebration" program and redoubled other motivational efforts. Established new processes. For example, any patient, for any reason, can now make a same-day appointment with a single call. Set patients' expectations. Printed and online materials educate patients about their stays--before they're admitted. Operating a truly patient-centered organization, the authors conclude, isn't a program; it's a way of life.
Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda
ABSTRACT: BACKGROUND: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four indicators of health care were...... assessed: Compliance with current guidelines on initiation of 1) combination antiretroviral therapy (cART), 2) chemoprophylaxis, 3) frequency of laboratory monitoring, and 4) virological response to cART (proportion of patients with HIV-RNA 90% of time on cART). RESULTS: 7097 Euro...... to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East and Argentina (adjusted OR 0.16[95%CI 0.11-0.23, p HIV health care utilization...
Bowman, Darcia Harris
The Broad Acres clinic is one of 1,500 school-based health centers nationwide that bring a wide range of medical, nutritional, and mental-health care to millions of students and their families. The centers provide an important safety net for children and adolescents--particularly the more than 10 million today who lack health insurance, according…
The liberalization of health care in the course of three decades of ‘reform and opening up’ has given people in rural China access to a diverse range of treatment options, but the health care system has also been marred by accusations of price hikes, fake pharmaceuticals, and medical malpractice...... roads to healing. The recent introduction of new rural cooperative medicine in the township represents an attempt to bring the state back in and address popular concern with the cost and quality of health care. While superficially reminiscent of the traditional socialist system, this new state attempt...
Botma, Yvonne; Botha, Hanlie; Nel, Mariette
The aim was to determine whether nursing leaders met the criteria for transformational and/or transactional leadership. Many changes have occurred in South Africa and are reflected in the health-care systems. As a result, it has become crucial to source leaders who are able to manage the change process effectively so as to ensure the success and survival of our health-care organizations. The 45-item multifactor leadership questionnaire (Rater) was completed by 41 respondents out of a population of 121. A proportional stratified simple random sampling technique was used to select the raters of seven leaders. Most nursing leaders role-modelled the culture of the organisation but did not stimulate their followers intellectually and did not demonstrate innovative motivation or individual consideration. Consequently, their followers may exhibit a lack of commitment to collective goals, with detrimental effects on the health-care organisation as a whole. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGERS: Nursing leaders should be trained to become transformational leaders so as to encourage their followers to become innovative and motivated to render high quality nursing care. © 2011 Blackwell Publishing Ltd.
Wylie, David A; Gallagher, Helen L
The aim of this study was to explore self-reported transformational leadership behavior profiles within the six largest allied health profession groups in the National Health Service in Scotland and to determine whether factors such as seniority of grade, locus of employment, and/or leadership training have a positive influence on transformational leadership behaviors. A postal survey comprising the shorter version of the Multifactorial Leadership Questionnaire (MLQ) and contextual demographic information was completed by 753 allied health professionals from four Health Board areas across Scotland who were randomly selected through a modified cluster sampling technique. The MLQ contains 36 items that measure nine identified leadership factors; however, only the responses to the five transformational leadership factors are reported here. The study identified significant differences in transformational leadership behaviors between individual allied health professions. Radiographers and podiatrists scored consistently lower than the other professional groups across the range of transformational behaviors. Seniority of grade significantly influenced the scores, with higher-graded staff reporting greater leadership behaviors (p leadership training also positively influenced transformational behaviors (p transformational leadership behaviors between individual allied health professions, indicating that some professional groups are inherently advantaged in embracing the modernization agenda. This highlights an as-yet missed opportunity for effectively targeting and evaluating multidisciplinary leadership training programs across the allied health professions.
2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, Nigeria. 1. 2. Adam V.Y , Iseh A.E. ABSTRACT. Introduction. The level of accurate knowledge adolescents have about HIV/AIDS, is important to enhance effective preventive actions, which ultimately result in a decrease in the incidence of ...
Enterobacter spp. 1. 0.6. Table V: Proportion of Respondent that enter the Ward with Handheld Device. Table VI: Proportion of Respondent that Disinfect Phones and what they Disinfect with. Table VII: Hand Hygiene Practices. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 27, NO 1, MARCH ...
globally, (Ischaemic heart diseases, Convention on Tobacco Control (FCTC), which. 5 cerebrovascular diseases, lower ... tract infections, chronic obstructive than 86% of the world's population. Tobacco pulmonary diseases ... and delivery of smoking cessation services among health care workers in Abuja. A cross sectional ...
Hollnagel, E.; Braithwaite, J.; Wears, R. L.
Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean...... production, and high reliability. This has on the whole been met with limited success because health care as a non-trivial and multifaceted system differs significantly from most traditional industries. In order to allow health care systems to perform as expected and required, it is necessary to have...... engineering's unique approach emphasises the usefulness of performance variability, and that successes and failures have the same aetiology. This book contains contributions from acknowledged international experts in health care, organisational studies and patient safety, as well as resilience engineering...
Jarzembski, W B
Today, health care engineering management is merely a concept of dreamers, with most engineering decisions in health care being made by nonengineers. It is the purpose of this paper to present a rationale for an integrated hospital engineering group, and to acquaint the clinical engineer with some of the salient features of management concepts. Included are general management concepts, organization, personnel management, and hospital engineering systems.
Oliveira, Beatriz Rosana Gonçalves de; Collet, Neusa; Viera, Cláudia Silveira
This study aims to reflect on humanization in health care, recovering the history of understanding about mankind, the human and humanity, until humanization in humanity and health. We discuss the national humanization program in hospital care and reflect on this proposal and on the issue of humanization in Brazilian health care nowadays. Communication is indispensable to establish humanization, as well as technical and material conditions. Both users and health professionals need to be heard, building a network of dialogues to think and promote singular humanization actions. For this process to take effect, there is a need to involve the whole that makes up the health service. This group involves different professionals, such as managers, public policy makers, professional councils and education institutions.
The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.
This paper presents a short discussion of essential concepts in primary health care based on the Alma Ata Declaration of 1978 and a brief description of the Philippine Ministry of Health primary health program. The phrase primary health care implies that PHC is a package of goods to be delivered to people, whereas in fact it is an approach to health care which emphasizes community involvement and participation in health development. Community participation is too often taken to mean that communities should participate in programs designed, implemented, and run by health professionals. PHC however requires that health programs be designed, implemented, run by, and belong to the people of the community. External agencies and health professionals must find ways of becoming involved and participating in the community's programs. A thorough reorientation of health professionals, particularly doctors and nurses, away from technology and toward the ideals and wisdom of the people is needed if PHC is to succeed. PHC should provide the bridge between technological knowledge and indigenous wisdom. The national government is embarking on a nationwide PHC program, with structures being organized at national, regional, provincial, municipal, and barangay levels for PHC. The higher organizational levels are intended to ensure access to their available resources to complement resources at the lower levels, especially at the critical barangay level. Because over 70% of the national population lives in rural areas, the national government's effort through the Ministry of Health will stress rural needs and approaches. Different approaches will be needed for poor urban communities, and the Manila Health Department may be able to provide leadership for developing the new ideas needed to tailor health development programs to Filipino urban communities.
Weel, C. van; Schers, H.J.; Timmermans, A.
This article analyzes Dutch experiences of health care reform--in particular in primary care--with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and
Jacobsen, Christian Bøtcher; Andersen, Lotte Bøgh; Serritzlew, Søren
An important task in governing health services is to control costs. The literatures on both costcontainment and supplier induced demand focus on the effects of economic incentives on health care costs, but insights from these literatures have never been integrated. This paper asks how economic cost...... containment measures affect the utilization of health services, and how these measures interact with the number of patients per provider. Based on very valid register data, this is investigated for 9.556 Danish physiotherapists between 2001 and 2008. We find that higher (relative) fees for a given service...... make health professionals provide more of this service to each patient, but that lower user payment (unexpectedly) does not necessarily mean higher total cost or a stronger association between the number of patients per supplier and the health care utilization. This implies that incentives...
Naccarella, Lucio; Butterworth, Iain; Moore, Timothy
With the recognition that professional education has not kept pace with the challenges facing the health and human service system, there has been a move to transformative education and learning professional development designed to expand the number of enlightened and empowered change agents with the competence to implement changes at an individual, organisation and systems level. Since 2010, the Department of Health and Human Services in Victoria, Australia, in collaboration with The University of Melbourne's School of Population and Global Health, has delivered seven population health short courses aimed to catalyse participants' transformation into population health change agents. This paper presents key learnings from a combination of evaluation data from six population health short courses using a transformative learning framework from a 2010 independent international commission for health professionals that was designed to support the goals of transformative and interdependent health professionals. Participatory realist evaluation approaches and qualitative methods were used. Evaluation findings reveal that there were mixed outcomes in facilitating participants' implementation of population health approaches, and their transformation into population health agents upon their return to their workplaces. Core enablers, barriers and requirements, at individual, organisational and system levels influence the capability of participants to implement population health approaches. The iterative and systemic evolution of the population health short courses, from a one off event to a program of inter-dependent modules, demonstrates sustained commitment by the short course developers and organisers to the promotion of transformative population health learning outcomes. To leverage this commitment, recognising that professional development is not an event but part of an ongoing transformative process, suggestions to further align recognition of population health
Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica
The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670
and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicaid is a federal and...living care. “Medicine has been slow to confront the very changes that it has been responsible for – or to apply the knowledge we already have about how...challenge to the nation. Challenges of the Industry As already outlined, a number of challenges confront the U.S. health care industry. Below are six
Marušič, Dorjan; Prevolnik Rupel, Valentina
In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.
Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.
Full Text Available Process Nursing Care (PAE is a systematic tool that facilitates the scientificity of care in community practice nurse, the application of scientific method in community practice, allows nursing to provide care in logical, systematic and comprehensive reassessing interventions to achieve the proposed results. It began with the valuation of Marjory Gordon Functional Patterns and then at the stage of diagnosis and planning North American Nursing Diagnosis Association (NANDA, Nursing Interventions Classification (NIC and Nursing Outcomes Classification (NOC is interrelate. It is a descriptive and prospective study. Diagnosis was made by applying the instruments measuring scale of the socio-demographic characteristics, symptom questionnaire for early detection of mental disorders in the community and appreciation for functional patterns. The PAE includes more frequent diagnoses, criteria outcomes, indicators, interventions and activities to manage community issues. alteration was evidenced in patterns: Adaptation and Stress Tolerance, Self-perception-Self-concept-, Role-Relationships, sleep and rest and Perception and Health Management. A standardized NANDA-NIC-NOC can provide inter care holistic care from the perspective of community mental health with a degree of scientific nature that frames the professional work projecting the individual, family and community care.
... Program SNF Requirements of Participation SNF Value-Based Purchasing (SNF VBP) Survey and Regulatory Therapy Services Workforce ... out, stay informed and spread. Looking for more information reguarding Prefered Provider Program Quality Care Book Store ... Nursing Home Administrator | Benedictine Health System US - MO - St. Louis, Qualifications Required: Bachelor’s degree ...
... Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Related MedlinePlus Health Topics Home Care Services Browse the Encyclopedia A.D.A.M., ...
Vrangbæk, Karsten; Byrkjeflot, Haldor
adjustment of such frameworks. In this article we present a framework for analyzing accountability within health care. The paper makes use of the concept of "accountability regime" to signify the combination of different accountability forms, directions and functions at any given point in time. We show...
Oberlies, Amanda Stefancyk
The American Organization of Nurse Executives conducted an evaluation of the hospitals participating in the Care Innovation and Transformation (CIT) program. A total of 24 hospitals participated in the 2-year CIT program from 2012 to 2013. Reported outcomes include increased patient satisfaction, decreased falls, and reductions in nurse turnover and overtime. Nurses reported statistically significant improvements in 4 domains of the principles and elements of a healthful practice environment developed by the Nursing Organizations Alliance.
Full Text Available Background. With the recognition that professional education has not kept pace with the challenges facing the health and human service system, there has been a move to transformative education and learning professional development designed to expand the number of enlightened and empowered change agents with the competence to implement changes at an individual, organisation and systems level. Design and Methods. Since 2010, the Department of Health and Human Services in Victoria, Australia, in collaboration with The University of Melbourne’s School of Population and Global Health, has delivered seven population health short courses aimed to catalyse participants’ transformation into population health change agents. This paper presents key learnings from a combination of evaluation data from six population health short courses using a transformative learning framework from a 2010 independent international commission for health professionals that was designed to support the goals of transformative and interdependent health professionals. Participatory realist evaluation approaches and qualitative methods were used. Results. Evaluation findings reveal that there were mixed outcomes in facilitating participants’ implementation of population health approaches, and their transformation into population health agents upon their return to their workplaces. Core enablers, barriers and requirements, at individual, organisational and system levels influence the capability of participants to implement population health approaches. The iterative and systemic evolution of the population health short courses, from a one off event to a program of inter-dependent modules, demonstrates sustained commitment by the short course developers and organisers to the promotion of transformative population health learning outcomes. Conclusions: To leverage this commitment, recognising that professional development is not an event but part of an ongoing transformative
Meadows, Carl A; Fraser, Julie; Camus, Susann; Henderson, Kathy
This article describes how a provincial health authority in Canada improved patient care and staff satisfaction by transforming the role of home care (HC) liaison. The transformation focused on clearly defining the role, function and reporting structure, and identifying which healthcare providers could fill the liaison role. The transformation included adoption of transition best practices, leveraging an electronic referral system, creation of an interprofessional team, standardization of tools/orientation, and strong evaluation metrics, centralizing decision making, and developing a process for streaming referrals. The authors identify key success factors that made the transformation possible, as well as challenges and work that remains to sustain the change.
Miller, William L; Cohen-Katz, Joanne
The renewal of primary care waits just ahead. The patient-centered medical home (PCMH) movement and a refreshing breeze of collaboration signal its arrival with demonstration projects and pilots appearing across the country. An early message from this work suggests that the development of collaborative, cross-disciplinary teams may be essential for the success of the PCMH. Our focus in this article is on training existing health care professionals toward being thriving members of this transformed clinical care team in a relationship-centered PCMH. Our description of the optimal conditions for collaborative training begins with delineating three types of teams and how they relate to levels of collaboration. We then describe how to create a supportive, safe learning environment for this type of training, using a different model of professional socialization, and tools for building culture. Critical skills related to practice development and the cross-disciplinary collaborative processes are also included. Despite significant obstacles in readying current clinicians to be members of thriving collaborative teams, a few next steps toward implementing collaborative training programs for existing professionals are possible using competency-based and adult learning approaches. Grasping the long awaited arrival of collaborative primary health care will also require delivery system and payment reform. Until that happens, there is an abundance of work to be done envisioning new collaborative training programs and initiating a nation-wide effort to motivate and reeducate our colleagues. PsycINFO Database Record (c) 2010 APA, all rights reserved.
Chin, Jean Lau; Yee, Barbara W K; Banks, Martha E
As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.
Corrigan, Patrick W; Diwan, Sarah; Campion, John; Rashid, Fadwa
Bass's (1990) multifactor model contrasts transformational and transactional styles of leadership with an essentially ineffective style: laissez-faire leadership. This study examines the relationship between these leadership styles and measures of organizational culture and staff burnout in mental health services teams. There were 236 leaders and 620 subordinates from 54 mental health teams who provided their perceptions of leadership style, organizational culture, and burnout in their program. Results show transformational leadership to be positively associated with a cohesive organizational culture and negatively associated with burnout. Moreover, leaders and subordinates differ in their ratings of transformational leadership-leaders viewed themselves more positively. These findings are helpful for understanding the central role of leaders in the organizational structure of teams.
Maher, Kevin O; Chang, Anthony C; Shin, Andrew; Hunt, Juliette; Wong, Hector R
The word innovation is derived from the Latin noun innovatus, meaning renewal or change. Although companies such as Google and Apple are nearly synonymous with innovation, virtually all sectors in our current lives are imbued with yearn for innovation. This has led to organizational focus on innovative strategies as well as recruitment of chief innovation officers and teams in a myriad of organizations. At times, however, the word innovation seems like an overused cliché, as there are now more than 5,000 books in print with the word "innovation" in the title. More recently, innovation has garnered significant attention in health care. The future of health care is expected to innovate on a large scale in order to deliver sustained value for an overall transformative care. To date, there are no published reports on the state of the art in innovation in pediatric health care and in particular, pediatric cardiac intensive care. This report will address the issue of innovation in pediatric medicine with relevance to cardiac intensive care and delineate possible future directions and strategies in pediatric cardiac intensive care. © The Author(s) 2015.
Aabenhus, Mette Morre; Schriver, Michael; Kallestrup, Per
Global health interventions often focus on specific diseases, thus forming vertical programmes. Studies show that vertical programmes perform poorly, which underlines the need for a horizontal basis: universal community-based primary health care, which improves health equity and outcomes. The diagonal approach supports an integrated patient-centered health-care system. The ''15% by 2015''-initiative suggests that vertical programmes invest 15% of their budgets in strengthening integrated primary health care. Strategies depend on local context.
Willis, Cameron D.; Best, Allan; Riley, Barbara; Herbert, Carol P.; Millar, John; Howland, David
Incremental approaches to introducing change in Canada's health systems have not sufficiently improved the quality of services and outcomes. Further progress requires 'large system transformation', considered to be the systematic effort to generate coordinated change across organisations sharing a common vision and goal. This essay draws on…
@hotmail.com, A.Ehigiegba@shell.com. KEYWORDS. Volunteer,. Obio Cottage. Hospital,. Participants,. Nigeria journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care.
... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Types of health care providers URL of this page: //medlineplus.gov/ency/article/001933.htm Types of health care providers To ...
... medlineplus.gov/ency/patientinstructions/000878.htm Understanding your health care costs To use the sharing features on this ... This is the payment you make for certain health care provider visits and prescriptions. It is a set ...
Fadope, Cece Modupe; And Others
A series of articles that examine environmental health and discuss health care reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for health care professionals who want to address…
The Family Dental Health Care Service is a new approach that includes efforts to serve oral and dental patients that focuses on maintenance, improvement and protection. This oral and dental health approach uses basic dentistry science and technology. The vision of the Family Dental Health Care Service is the family independences in the effort of dental health maintenance and to achieve the highest oral and dental health degree as possible through family dentist care that is efficient, effecti...
Schieber, G J; Puollier, J P
Trends in health are reviewed for the member countries of the Organization for Economic Cooperation and Development (OECD) covering the following: the basic difficulties inherent in international comparative studies; the absolute levels of health expenditures in 1984; the levels and rates of growth of the health share in the gross domestic product (GDP) and the public share of total health expenditures; the elasticities of real health expenditures to real GDP for the 1960-75, 1975-84, and 1960-84 time periods; growth in health expenditures for the largest 7 OECD countries in terms of growth in population, health prices, health care prices in excess of overall prices, and utilization/intensity of services per person. International comparisons are a problem due to differences in defining the boundaries of the health sector, the heterogeneity of data, and methodological problems arising from comparing different economic, demographic, cultural, and institutional structures. The most difficult problem in international comparisons of health expenditures is lack of appropriate measures of health outcome. Exhibit 1 contains per capita health expenditures denominated in US dollars based on GDP purchasing power parities for 21 OECD countries for 1984. Per capita health expenditures ranged from less than $500 in Greece, Portugal, and Spain to over $1400 in Sweden and the US, with an OECD average of $871. After adjusting for price level differences, there still appears to be a greater than 3-fold difference in the "volume" of services consumed across the OECD countries. To determine if per capita health expenditures are related to a country's wealth as measured by its per capita GDP, the relationship between per capita health expenditures and per capita GDP for the 21 countries were examined for 1984. The data points and the "best fitting" trend line indicate a statistically significant relationship in which each $100 difference in per capita GDP is associated with a $10
Günzel-Jensen, Franziska; Jain, Ajay K.; Kjeldsen, Anne Mette
Management and health care literature is increasingly preoccupied with leadership as a collective social process, and related leadership concepts such as distributed leadership have therefore recently gained momentum. This paper investigates how formal, i.e. transformational, transactional...... and empowering, leadership styles affect employees’ perceived agency in distributed leadership, and whether these associations are mediated by employees’ perceived organizational efficacy. Based on large-scale survey data from a study at one of Scandinavia’s largest public hospitals (N = 1,147), our results show...... that all leadership styles had a significant positive impact on employees’ perceived agency in distributed leadership. Further, organizational efficacy related negatively to employees’ perceived agency in distributed leadership; however a mediatory impact of this on the formal leadership styles...
The Mental Health Care Act was promulgated in December 2004. Although this was not unexpected, the timing had certainly not been anticipated. Overnight the mental health care landscape was transformed. Not only had all of our professional designations been collapsed into a single entity of “mental health.
Part II of Health Care Engineering begins with statistics on the occurrence of medical errors and adverse events, and includes some technological solutions. A chapter on electronic medical records follows. The knowledge management process divided into four steps is described; this includes a discussion on data acquisition, storage, and retrieval. The next two chapters discuss the other three steps of the knowledge management process (knowledge discovery, knowledge translation, knowledge integration and sharing). The last chapter briefly discusses usability studies and clinical trials.This two-
Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter
The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precis......, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation...
Full Text Available A general descrition of the initiation of a palliative care program in Kenya using a transformational development, participatory and empowering approach, with lessons learned and description of subsequent impact.
... Adult Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap ... Centers Hospice Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare ...
Sebben Ojeda, Beatriz
The aim of this study is revealing the work process development of nurses which in the child care area and to understand how paradigmatical transformations of model and care occur from the daily experience. The participants were tem (10) nurses, all of them, females of long experience in the area of child care. This investigation follows the four steps indicated by Giorgi (1985) and Comiotto (1992). The results showed four phenomenological essences: the discovery of the child care significanc...
McDonald, Patricia A; Mecklenburg, Robert S; Martin, Lindsay A
To tame its soaring health care costs, intel tried many popular approaches: "consumer-driven health care" offerings such as high-deductible/low-premium plans, on-site clinics and employee wellness programs. But by 2009 intel realized that those programs alone would not enable the company to solve the problem, because they didn't affect its root cause: the steadily rising cost of the care employees and their families were receiving. Intel projected that its health care expenditures would hit a whopping $1 billion by 2012. So the company decided to try a novel approach. As a large purchaser of health services and with expertise in quality improvement and supplier management, intel was uniquely positioned to drive transformation in its local health care market. The company decided that it would manage the quality and cost of its health care suppliers with the same rigor it applied to its equipment suppliers by monitoring quality and cost. It spearheaded a collaborative effort in Portland, Oregon, that included two health systems, a plan administrator, and a major government employer. So far the Portland collaborative has reduced treatment costs for certain medical conditions by 24% to 49%, improved patient satisfaction, and eliminated over 10,000 hours worth of waste in the two health systems' business processes.
Foss Durant, Anne; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy
In early 2010, leaders within Kaiser Permanente (KP) Northern California's Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes.
Client Satisfaction with Antenatal Care Services in Primary Health Care. Centres in Sabon Gari Local Government Area, Kaduna State Nigeria. journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. 1. 1. 1. M.B Sufiyan , A.A Umar , A. Shugaba . 1Department of Community Medicine, Ahmadu Bello University, ...
Petrochuk, M A; Javalgi, R G
Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.
Health care workers are exposed to many job hazards. These can include Infections Needle injuries Back injuries ... prevention practices. They can reduce your risk of health problems. Use protective equipment, follow infection control guidelines, ...
G. Alan Tarr
Full Text Available President Barack Obama proposed a major overhaul of the American healthsystem, and in 2010 the U.S. Congress enacted his proposal, the PatientProtection and Affordable Care Act. Opponents of the Act challenged itsconstitutionality in federal court, claiming that it exceeds the powers grantedto the federal government under the Commerce Clause and the NecessaryProper Clause of the federal Constitution. Some courts have upheldthe law, but others have agreed with the critics, in particular ruling thatthe provision requiring citizens to buy health insurance is unconstitutional.Eventually the U.S. Supreme Court will rule on the issue. This article tracesthe controversy, surveys the interpretation of pertinent constitutional provisionsin past cases, analyzes the constitutional arguments presented byproponents and opponents of the Act, and concludes that the Act is constitutional.
Brown, Judith Belle; French, Reta; McCulloch, Amy; Clendinning, Eric
Abstract Objective To explore the knowledge and perceptions of fourth-year medical students regarding the new models of primary health care (PHC) and to ascertain whether that knowledge influenced their decisions to pursue careers in family medicine. Design Qualitative study using semistructured interviews. Setting The Schulich School of Medicine and Dentistry at The University of Western Ontario in London. Participants Fourth-year medical students graduating in 2009 who indicated family medicine as a possible career choice on their Canadian Residency Matching Service applications. Methods Eleven semistructured interviews were conducted between January and April of 2009. Data were analyzed using an iterative and interpretive approach. The analysis strategy of immersion and crystallization assisted in synthesizing the data to provide a comprehensive view of key themes and overarching concepts. Main findings Four key themes were identified: the level of students’ knowledge regarding PHC models varied; the knowledge was generally obtained from practical experiences rather than classroom learning; students could identify both advantages and disadvantages of working within the new PHC models; and although students regarded the new PHC models positively, these models did not influence their decisions to pursue careers in family medicine. Conclusion Knowledge of the new PHC models varies among fourth-year students, indicating a need for improved education strategies in the years before clinical training. Being able to identify advantages and disadvantages of the PHC models was not enough to influence participants’ choice of specialty. Educators and health care policy makers need to determine the best methods to promote and facilitate knowledge transfer about these PHC models. PMID:22518904
Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.
Piper, Llewellyn E
Hospitals in America face a daunting and historical challenge starting in 2013 as leadership navigates their organizations toward a new port of call-the Patient Protection and Affordable Care Act. Known as the Affordable Care Act (ACA) was signed into law in March 2010 and held in abeyance waiting on 2 pivotal points-the Supreme Court's June 2012 ruling upholding the constitutionality of the ACA and the 2012 presidential election of Barack Obama bringing to reality to health care organizations that leadership now must implement the mandates of health care delivery under the ACA. This article addresses the need for value-based leadership to transform the culture of health care organizations in order to be successful in navigating uncharted waters under the unprecedented challenges for change in the delivery of quality health care.
Tracy, Jane; McDonald, Rachael
Background: Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care.…
Williams, Lisa-Mae; Hubbard, Kenneth E; Daye, Olive; Barden, Connie
In tele-intensive care units, informatics, telecommunication technology, telenursing, and telemedicine are merged to provide expert, evidence-based, and cutting-edge services to critically ill patients. Telenursing is an emerging subspecialty in critical care that is neither well documented in the extant literature nor well understood within the profession. Documentation and quantification of telenursing interventions help to clarify the impact of the telenurse's role on nursing practice, enhancement of patient care, patient safety, and outcomes. Tele-intensive care unit nursing will continue to transform how critical care nursing is practiced by enhancing/leveraging available resources through the use of technology.
Port Harcourt. ... Journal of Community Medicine and Primary Health Care. 25 (2) 53-58. KEYWORDS. Healer shopping,. Discharge Against. Medical Advice,. Non- communicable diseases, epidemiological transition, Port.
Roussel, Linda; Dearmon, Valorie; Buckner, Ellen; Pomrenke, Becky; Salas, Sheri; Mosley, Aimee; Brown, Stephanie
How do nurses commit to effecting change, the kind of change that will transform both care received and the caregiver? This was the mission of Transforming Care at the Bedside, the 2003 initiative sponsored by the Robert Wood Johnson Foundation and the Institute of Healthcare Improvement. OBSERVATIONS AND OBJECTIVES: This analysis reflects processes and context of unit change through Transforming Care at the Bedside. Organizational leadership includes engagement in change. Descriptions of change process were solicited from stakeholder interviews and focus groups to evaluate and make recommendations for the future. Stakeholders recognized that "Change can be good!" Reflection and strategic evaluation strengthen planning for sustainability supporting staff engagement and transformational leadership in an academic health science setting.
Dávila Torres, Javier
The politics as an activity oriented to the decision making process, seeks to achieve specific objectives, and it is a fundamental tool for the transformation of the National Health System (NHS). It is important to point out that there are different elements, interest and participants that take part in the design and implementation of these policies. Therefore, it should be considered the presence of the health care institutions in the development of the health policies, as well as the participation of the Congress where each political party presents and defends their proposals, negotiate the approval and assignation of the financial budget, among others. Nowadays, there are elements with a relevant presence on these policies and in the transformation process of the NHS such as the media and laboral force represented by the unions. Finally, some general statements are expressed to contribute with the advances in the integration process for a stronger NHS. This should consider the economic, demographic and social changes in the country; furthermore it should focus on universal coverage and provision of a better health care for the Mexican population.
1Department of Paediatrics and Child Health, Faculty of Clinical Sciences, College of Health Sciences,. Obafemi Awolowo ... Younger parents less than 35years, parents with lower educational attainments and low .... staffing, availability of immunization consumables was estimated using the Computer Programme for.
financing are critical issues that continue to bother health policy makers. .... Ethical approval. Ethical approval was obtained from the. Health Research Ethics Committee of the Delta. State University Teaching Hospital, Oghara and informed written (and or verbal) ... Teachers/Religious Leaders. Indifferent. 85. 24.3%. 117.
Background: Quarry industry has become a major means of livelihood in Ebonyi state, but insufficient data exists on their operations and use of control measures like dust mask, with no serious attempt at comprehensive health education. The study sought to assess the effect of health education on the perception and ...
mania) and anxiety disorders (General anxiety, agoraphobia, social phobia, obsessive-compulsive disorder and post traumatic stress disorder). Conclusion: Findings suggest that there is need to consider mental and psychological care of clients with HIV/AIDS to minimise the prevalence of psychiatric disorder among HIV ...
Methodology. A cross-sectional survey of patients at the antiretroviral clinic of the Federal Medical Centre,. Makurdi, Nigeria, was conducted between June and August 2008. An adapted version of the RAND. Patient Satisfaction Questionnaire Long Form was used to assess seven dimensions of care: general satisfaction ...
Jones, W. L.
Space age health care delivery is being delivered to both NASA astronauts and employees with primary emphasis on preventive medicine. The program relies heavily on comprehensive health physical exams, health education, screening programs and physical fitness programs. Medical data from the program is stored in a computer bank so epidemiological significance can be established and better procedures can be obtained. Besides health care delivery to the NASA population, NASA is working with HEW on a telemedicine project STARPAHC, applying space technology to provide health care delivery to remotely located populations.
Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.
Full Text Available The Family Dental Health Care Service is a new approach that includes efforts to serve oral and dental patients that focuses on maintenance, improvement and protection. This oral and dental health approach uses basic dentistry science and technology. The vision of the Family Dental Health Care Service is the family independences in the effort of dental health maintenance and to achieve the highest oral and dental health degree as possible through family dentist care that is efficient, effective, fair, evenly distributed, safe and has a good quality. To support this effort, the Ministry of Health has issued Health Care Policy and Implementation Guideline as well as the licensing standard for family dentist practice.
McDavid, Lolita M
Children in foster care need more from health providers than routine well-child care. The changes in legislation that were designed to prevent children from languishing in foster care also necessitate a plan that works with the child, the biological family, and the foster family in ensuring the best outcome for the child. This approach acknowledges that most foster children will return to the biological family. Recent research on the effect of adverse childhood experiences across all socioeconomic categories points to the need for specifically designed, focused, and coordinated health and mental health services for children in foster care. Copyright © 2015 Elsevier Inc. All rights reserved.
Nautical tourism is one of the developing branches of tourism in Europe. It differs from other forms of tourism. Conditions under which nautical tourists live are similar to those of seamen employed on vessels in costal shipping. The health care for nautical tourists should be organized according to the principles of health care for crews of merchant ships engaged in constal shipping.
communicable diseases such as hypertension and transitions currently experienced in Sub-Saharan. 96. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. KEYWORDS journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. Journal of Community Medicine ...
This editorial reviews areas of health care reform including managed health care, diagnosis-related groups, and the Resource-Based Relative Value Scale for physician services. Relevance of such reforms to people with developmental disabilities is considered. Much needed insurance reform is not thought to be likely, however. (DB)
PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26 (1) 21-29. KEYWORDS. Household, expenditure,. Treatment, presumptive malaria,. Gimba ... A cross-sectional descriptive study conducted during community diagnosis posting of final year medical students of. Ahmadu Bello University ...
Margolis, Lewis; Mullenix, Amy; Apostolico, Alexsandra A; Fehrenbach, Lacy M; Cilenti, Dorothy
Purpose The National Maternal and Child Health Workforce Development Center at UNC Chapel Hill (the Center), funded by the Maternal and Child Health Bureau, provides Title V state/jurisdiction leaders and staff and partners from other sectors with opportunities to develop skills in quality improvement, systems mapping and analysis, change management, and strategies to enhance access to care to leverage and implement health transformation opportunities to improve the health of women and children. Description Since 2013, the Center has utilized a variety of learning platforms to reach state and jurisdiction Title V leaders. In the intensive training program, new skills and knowledge are applied to a state-driven health transformation project and include distance-based learning opportunities, multi-day, in-person training and/or onsite consultation, as well as individualized coaching to develop workforce skills. Assessment The first intensive cohort of eight states reported enhanced skills in the core areas of quality improvement, systems mapping and analysis, change management, and strategies to enhance access to care which guided changes at state system and policy levels. In addition, teams reported new and/or enhanced partnerships with many sectors, thereby leveraging Title V resources to increase its impact. Conclusion The Center's provision of core workforce skills and application to state-defined goals has enabled states to undertake projects and challenges that not only have a positive impact on population health, but also encourage collaborative, productive partnerships that were once found to be challenging-creating a workforce capable of advancing the health and wellbeing of women and children.
Beatty, Rebecca M.
Survey responses from 71 health professionals, benchmarking data from 8 hospitals, continuing education program evaluations, and focus groups with nursing, allied health, and primary care providers indicated a need for professional continuing education on women's health issues. Primary topic needs were identified. The data formed the basis for…
Miles, Stephen H.; And Others
A discussion of the role of academic health centers in health care reform efforts looks at the following issues: balancing academic objectivity and social advocacy; managing sometimes divergent interests of centers, faculty, and society; and the challenge to develop infrastructure support for reform. Academic health centers' participation in…
May 1, 2012 ... Results: The findings reveal different modes money was made available for payment for health services. On the whole, about 98% of payment was through out-of pocket spending (user-charges) with most respondents using their own money. Although this financing method shown to be associated with ...
2Department of Community Health, University of Benin Teaching Hospital, Benin City, Edo State. 1. 2. 2. Awunor N.S , Omuemu V.O , Adam V.Y. ABSTRACT. Introduction. A nation's disease control effort is often as good as the surveillance and notification system put in place, which would help to generate the much needed ...
living on each square inch of the phone. This study determined the prevalence of micro-organisms on the mobile phones of health workers and their role as a source of hospital acquired infection. The study utilised a cross-sectional design. A total of one hundred and eighty swabs were collected from the mobile phones of ...
child deaths among under-fives were due to. Childhood immunization is an effective public. VPDs, this represents 17% of global total. 1 health initiative aimed at reducing the burden mortality in children under five years of age. of vaccine preventable diseases (VPDs) and. To achieve the Millennium Developmental.
Oct 7, 2011 ... These factors include poor environmental and personal hygiene, poverty, malnutrition, unsafe water supply and ... The environment farmers live in, their standard of living and nutrition are very important to their health. ..... Globalization of food system: JOURNAL OF COMMUNITY MEDICINE AND PRIMARY ...
instruments were pretested self-administered questionnaire and observational checklist. The data generated were analyzed using .... The observational checklist (OBL) was used to. Kwara State was carried from April to ..... supervision of health workers by middle cadre Central Zonal Office). Report on Routine immunization ...
Further studies on this subject are recommended. Employees' Assessment of Leadership in a Tertiary. Hospital in South-South Nigeria. Adeleye O. A, Aduh U. Department of Community Health, .... National Institute of Standards and Technology, (where it is trying to go in the future)”; “my senior were originally designed for ...
Leanza, Francesco; Hauser, Diane
Teens are avid users of new technologies and social media. Nearly 95% of US adolescents are online at least occasionally. Health care professionals and organizations that work with teens should identify online health information that is both accurate and teen friendly. Early studies indicate that some of the new health technology tools are acceptable to teens, particularly texting, computer-based psychosocial screening, and online interventions. Technology is being used to provide sexual health education, medication reminders for contraception, and information on locally available health care services. This article reviews early and emerging studies of technology use to promote teen health. Copyright © 2014 Elsevier Inc. All rights reserved.
Mastrototaro, John J
The health care industry is undergoing a major transformation. Despite spending more on health care than any other country, the United States has not seen a commensurate improvement in the quality of care. Chronic disease management puts the greatest burden on the health care system with estimates suggesting that 3 of 4 health care dollars are spent on managing chronic disease. Moreover, the number of older patients with chronic conditions, like diabetes, is rising as expected, which only serves to worsen the physician shortage problem we are currently experiencing, and further increase health care costs. Unless new models of health care are established for these patients, they simply will not be served. Consistent with the message above, there are generally 3 universal health care needs, (1) improved outcomes, (2) expanded access, and (3) optimized cost and efficiency. It is likely the future state will involve value-based health care, with payment based on outcomes, not services rendered, and incentives tied more directly to the value delivered. Medical device providers will be held more accountable for positive outcomes, and to ensure success, they will need to create better solutions with their therapies. Instead of the touch point with patients being solely at the time of a procedure or sale of the device, it is likely companies will need to drive toward a more comprehensive partnership with patients, providers, and payers, extending the scope of services and interactions to provide a continuum of care. In general, companies will need to start to think of their most important customers as people living with a condition, as opposed to patients needing immediate medical devices. In this article, I discuss the challenges of health care today and present some of the opportunities to revamp health care delivery in diabetes by leveraging the pervasive use of mobile technologies and digital data. © 2015 Diabetes Technology Society.
Miles, S H; Lurie, N; Fisher, E S; Haugen, D
There is increasing support for the proposition that academic health centers have a duty to accept broad responsibility for the health of their communities. The Health of the Public program has proposed that centers become directly involved in the social-political process as advocates for reform of the health care system. Such engagement raises important issues about the roles and responsibilities of centers and their faculties. To address these issues, the authors draw upon the available literature and their experiences in recent health care reform efforts in Minnesota and Vermont in which academic health center faculty participated. The authors discuss (1) the problematic balance between academic objectivity and social advocacy that faculty must attempt when they engage in the health care reform process; (2) the management of the sometimes divergent interests of academic health centers, some of their faculty, and society (including giving faculty permission to engage in reform efforts and developing a tacit understanding that distinguishes faculty positions on reform issues from the center's position on such issues); and (3) the challenge for centers to develop infrastructure support for health reform activities. The authors maintain that academic health centers' participation in the process of health care reform helps them fulfill the trust of the public that they are obligated to and ultimately depend on.
Racial and Ethnic Disparities in Health and Health Care: an Assessment and Analysis of the Awareness and Perceptions of Public Health Workers Implementing a Statewide Community Transformation Grant in Texas.
Akinboro, Oladimeji; Ottenbacher, Allison; Martin, Marcus; Harrison, Roderick; James, Thomas; Martin, Eddilisa; Murdoch, James; Linnear, Kim; Cardarelli, Kathryn
Little is known about the awareness of public health professionals regarding racial and ethnic disparities in health in the United States of America (USA). Our study objective was to assess the awareness and perceptions of a group of public health workers in Texas regarding racial health disparities and their chief contributing causes. We surveyed public health professionals working on a statewide grant in Texas, who were participants at health disparities' training workshops. Multivariable logistic regression was employed in examining the association between the participants' characteristics and their perceptions of the social determinants of health as principal causes of health disparities. There were 106 respondents, of whom 38 and 35 % worked in health departments and non-profit organizations, respectively. The racial/ethnic groups with the highest incidence of HIV/AIDS and hypertension were correctly identified by 63 and 50 % of respondents, respectively, but only 17, and 32 % were knowledgeable regarding diabetes and cancer, respectively. Seventy-one percent of respondents perceived that health disparities are driven by the major axes of the social determinants of health. Exposure to information about racial/ethnic health disparities within the prior year was associated with a higher odds of perceiving that social determinants of health were causes of health disparities (OR 9.62; 95 % CI 2.77, 33.41). Among public health workers, recent exposure to information regarding health disparities may be associated with their perceptions of health disparities. Further research is needed to investigate the impact of such exposure on their long-term perception of disparities, as well as the equity of services and programs they administer.
Steiner, Rose M.; Walsworth, David T.
Introduction: Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality…
Agartan, Tuba I
The health care industry is labor intensive and depends on well-trained and appropriately deployed health professionals to deliver services. This article examines the health workforce challenges in the context of Turkey's recent health reform initiative, Health Transformation Program (HTP). Reformers identified shortages, imbalances in the skills-mix, and inequities in the geographical distribution of health professionals as among the major problems. A comprehensive set of policies was implemented within the HTP framework to address these problems. The article argues that these policies addressed some of the health workforce challenges, while on the other hand exacerbating others and hence may have resulted in increasing the burden on the workforce. So far HTP's governance reforms and health human resource policy have not encouraged meaningful participation of other key stakeholders in the governance of the health care system. Without effective participation of health professionals, the next stages of HTP implementation that focus on managerial reforms such as restructuring public hospitals, improving the primary care system and implementing new initiatives on quality improvement could be very difficult. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Abstract Background The professional organization of medical work no longer reflects the changing health needs caused by the growing number of complex and chronically ill patients. Key stakeholders enforce coordination and remove power from the medical professions in order allow for these changes. However, it may also be necessary to initiate basic changes to way in which the medical professionals work in order to adapt to the changing health needs. Discussion Medical leaders, supported by health policy makers, can consciously activate the self-regulatory capacity of medical professionalism in order to transform the medical profession and the related professional processes of care so that it can adapt to the changing health needs. In doing so, they would open up additional routes to the improvement of the health services system and to health improvement. This involves three consecutive steps: (1 defining and categorizing the health needs of the population; (2 reorganizing the specialty domains around the needs of population groups; (3 reorganizing the specialty domains by eliminating work that could be done by less educated personnel or by the patients themselves. We suggest seven strategies that are required in order to achieve this transformation. Summary Changing medical professionalism to fit the changing health needs will not be easy. It will need strong leadership. But, if the medical world does not embark on this endeavour, good doctoring will become merely a bureaucratic and/or marketing exercise that obscures the ultimate goal of medicine which is to optimize the health of both individuals and the entire population.
Jeffs, Lianne; Nincic, Vera; White, Peggy; Hayes, Laureen; Lo, Joyce
A study was undertaken to gain insight into how nurse leaders are influencing the use of performance data to improve nursing care in hospitals. Two themes emerged: getting relevant, reliable, and timely data into the hands of nurses, and the leaders' ability to "connect the dots" in working with different stakeholders. Study findings may inform nurse leaders in their efforts to leverage data to transform nursing care.
Full Text Available Abstract Background Developments in information technology promise to revolutionise the delivery of health care by providing access to data in a timely and efficient way. Information technology also raises several important concerns about the confidentiality and privacy of health data. New and existing legislation in Europe and North America may make access to patient level data difficult with consequent impact on research and health surveillance. Although research is being conducted on technical solutions to protect the privacy of personal health information, there is very little research on ways to improve individuals power over their health information. This paper proposes a health care information directive, analogous to an advance directive, to facilitate choices regarding health information disclosure. Results and Discussion A health care information directive is described which creates a decision matrix that combines the ethical appropriateness of the use of personal health information with the sensitivity of the data. It creates a range of possibilities with in which individuals can choose to contribute health information with or without consent, or not to contribute information at all. Conclusion The health care information directive may increase individuals understanding of the uses of health information and increase their willingness to contribute certain kinds of health information. Further refinement and evaluation of the directive is required.
Alami, Hassane; Gagnon, Marie-Pierre; Fortin, Jean-Paul
Information and communication technologies have transformed all sectors of society. The health sector is no exception to this trend. In light of "digital health", we see multiplying numbers of web platforms and mobile health applications, often brought by new unconventional players who produce and offer services in non-linear and non-hierarchal ways, this by multiplying access points to services for people. Some speak of a "uberization" of healthcare. New realities and challenges have emerged from this paradigm, which question the abilities of health systems to cope with new business and economic models, governance of data and regulation. Countries must provide adequate responses so that digital health, based increasingly on disruptive technologies, can benefit for all.
Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie
During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.
Wheatley, Laura; Doyle, Winnie; Evans, Cheryl; Gosse, Carolyn; Smith, Kevin
Calls for transformational change of our healthcare system are increasingly clear, persuasive and insistent. They resonate at all levels, with those who fund, deliver, provide and receive care, and they are rooted in a deep understanding that the system, as currently rigidly structured, most often lacks the necessary flexibility to comprehensively meet the needs of patients across the continuum of care. The St. Joseph's Health System (SJHS) Integrated Comprehensive Care (ICC) Program, which bundles care and funding across the hospital to home continuum, has reduced fragmentation of care, and it has delivered improved outcomes for patients, providers and the system. This case study explores the essential contribution of nursing leadership to this successful transformation of healthcare service delivery.
The health economy is a significant part of a national economy accounting typically for about 8% of GDP spent. As national economies respond to the dual challenges of severe economic turbulence on the global scale and climate change mitigation, the health economy is coming under increasing pressure to respond. Indications for sharp reductions in budgets and reductions in greenhouse gas emissions, such as carbon dioxide, are widespread. In this paper an analysis is undertaken of the diverse forces acting on a typical health care enterprise. The forces, both economic and carbon related, are investigated in terms of their effects through the enterprise and across its boundaries on the supply, demand and waste sides. The overall aim is to show how the enterprise and whole supply chains may flip synchronously into a low-carbon evolutionary pathway. By illustrating how different elements of the health care enterprise may respond to these developments, diverse opportunities for cost reduction, carbon reduction and product (goods and services) development are identified. These opportunities involve a variety of waste reduction and energy and materials conservation measures as well as new ways of collaborating with other enterprises going through similar transformations. The overall objective is to show that the carbon-constrained health care enterprise and the low-carbon health economy in which it sits may broaden its role in the coming decades to include a degree of responsibility for the health of the environment. This broader role is likely to supplement and entangle with the traditional role of the health economy, currently focused narrowly on human health, and lead to extensive organisational transformation, and infrastructure and product developments.
health care and reproductive health. It plays a major role in reducing maternal and neonatal morbidity. Access to family planning also has the and mortality. It confers important health and potential to control population growth and in the development benefits to individuals, families, long run reduce green house gas emission ...
activities in the health centres ( Table 2) The study showed that community health extension workers were responsible for ... development goals for mothers and children as distant as it was 40 years ago when primary health care strategy was adopted for ... Most of them were very experienced, 50% of. The study (Table II) ...
Andersen, Kim Normann; Medaglia, Rony; Henriksen, Helle Zinner
This paper investigates the impacts of social media use in Danish public health care with respect to capabilities, interactions, orientations, and value distribution. Taking an exploratory approach, the paper draws on an array of quantitative and qualitative data, and puts forward four propositions......: social media transform the access to health-related information for patients and general practitioners, the uptake of social media can be a cost driver rather than a cost saver, social media provide empowerment to patients, and the uptake of social media is hindered by legal and privacy concerns...
Full Text Available The paper deals with conscientious objection in health care, addressing the problems of scope, verification and limitation of such refusal, paying attention to ideological agendas hidden behind the right of conscience where the claimed refusal can cause harm or where such a claim is an attempt to impose certain moral values on society or an excuse for not providing health care. The nature of conscientious objection will be investigated and an ethical analysis of conscientious objection will be conducted. Finally some suggestions for health care policy will be proposed.
Green, Amy E; Miller, Elizabeth A; Aarons, Gregory A
Public sector mental health care providers are at high risk for burnout and emotional exhaustion which negatively affect job performance and client satisfaction with services. Few studies have examined ways to reduce these associations, but transformational leadership may have a positive effect. We examine the relationships between transformational leadership, emotional exhaustion, and turnover intention in a sample of 388 community mental health providers. Emotional exhaustion was positively related to turnover intention, and transformational leadership was negatively related to both emotional exhaustion and turnover intention. Transformational leadership moderated the relationship between emotional exhaustion and turnover intention, indicating that having a transformational leader may buffer the effects of providers' emotional exhaustion on turnover intention. Investing in transformational leadership development for supervisors could reduce emotional exhaustion and turnover among public sector mental health providers.
Green, Amy E.; Miller, Elizabeth A.; Aarons, Gregory A.
Public sector mental health care providers are at high risk for burnout and emotional exhaustion which negatively affect job performance and client satisfaction with services. Few studies have examined ways to reduce these associations, but transformational leadership may have a positive effect. We examine the relationships between transformational leadership, emotional exhaustion, and turnover intention in a sample of 388 community mental health providers. Emotional exhaustion was positively related to turnover intention, and transformational leadership was negatively related to both emotional exhaustion and turnover intention. Transformational leadership moderated the relationship between emotional exhaustion and turnover intention, indicating that having a transformational leader may buffer the effects of providers’ emotional exhaustion on turnover intention. Investing in transformational leadership development for supervisors could reduce emotional exhaustion and turnover among public sector mental health providers. PMID:22052429
U.S. Department of Health & Human Services — A list of all Home Health Agencies that have been registered with Medicare. The list includes addresses, phone numbers, and quality measure ratings for each agency.
Full Text Available The author presents the process of transforming residential institutional care and foster family care in the Slovak Republic at three levels. It is a socio-political context that led firstly to the fact that "education" and "health" orphanages passed into the social sector, secondly, the continuity of the changes was disrupted. They rejected any experience from the previous period and gradually liquidated almost everything that was associated with education. On the second level the author states selected "transformation" proclamation expectations, but also some practical steps associated with the transformation campaign. On the third level the author reflects some current technical problems of substitute care arising from 'political' awarding, poor quality and lack of respect for psychological and pedagogical knowledge.
Meredith, Lisa S; Schmidt Hackbarth, Nicole; Darling, Jill; Rodriguez, Hector P; Stockdale, Susan E; Cordasco, Kristina M; Yano, Elizabeth M; Rubenstein, Lisa V
Transformation of primary care to new patient-centered models requires major changes in healthcare organizations, including interprofessional expectations and organizational policies. Emotional exhaustion (EE) among workers can accompany major organizational change, threatening its success. Yet little guidance exists about the magnitude of associations with EE during primary care transformation. We assessed EE during the initial phase of national primary care transformation in the Veterans Health Administration. Cross-sectional online surveys of primary care clinicians (PCCs) and staff in 23 primary care clinics within 5 healthcare systems in 1 veterans administration administrative region. We used descriptive, bivariate, and multivariable analyses adjusted for clinic membership and weighted for nonresponse. 515 veterans administration employees (191 PCCs and 324 other primary care staff). Outcome is the EE subscale of the Maslach Burnout Inventory. Predictors include clinic characteristics (from administrative data) and self-reported efficacy for change, experiences with transformation, and perspectives about the organization. The overall response rate was 64% (515/811). In total, 53% of PCCs and 43% of staff had high EE. PCCs (vs. other primary care staff), female (vs. male), and non-Latino (vs. Latino) respondents reported higher EE. Respondents reporting higher efficacy for change and participatory decision making had lower EE scores, adjusting for sex and race. Recognition by healthcare organizations of the potential for clinician and staff EE during primary care transformation is critical. Methods for reducing EE by increasing clinician and staff change efficacy and opportunities to participate in decision making should be considered, with attention to PCCs, and women.
... Sloane PD, Warshaw GA, et al, eds. Ham's Primary Care Geriatrics: A Case-Based Approach . 6th ed. ... Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, ...
Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost
In the United States and globally, healthcare delivery is in the midst of an acute transformation with the adoption and use of health information technology (health IT) thus generating increasing amounts of patient care data available in computable form. Secure and trusted use of these data, beyond their original purpose can change the way we think about business, health, education, and innovation in the years to come. "Big Data" is data whose scale, diversity, and complexity require new architecture, techniques, algorithms, and analytics to manage it and extract value and hidden knowledge from it.
Full Text Available Health care organizations have to develop a sustainable path for creating public value by seeking legitimacy for building and maintaining public trust with patients as social and economic institutions creating value and sustaining both health and wealth for people and communities within society. Health care organizations having at disposal decreasing resources and meeting increasing demands of citizens are following an unsustainable path. Designing sustainable health care systems and organizations is emerging as a strategic goal for developing the wealth of people and communities over time. Building sustainable organizations relies on valuing human resources, designing efficient and effective processes, using technology for better managing the relationships within and outside organizations. Sustainable health care organizations tend to rediscover the importance of human resource management and policies for effectively improving communication with patients and building trust-based relationships. While processes of accreditation contribute to legitimizing effectiveness and quality of health care services and efficient processes, introducing and using new information and communication technologies (ICTs and informatics helps communication leading to restore trust-based relationships between health care institutions and patients for value creation within society.
Ward, Lizzie; Barnes, Marian
This article explores the relevance of deliberative practices framed by feminist care ethics to social work practice with older people. It draws on two connected projects which brought together older people: practitioners and academics. The first was a participatory research project in which the significance of care to well-being in old age emerged. The second was a knowledge exchange project which generated learning resources for social care practice based on the research findings of the first project. Here we analyse selected transcripts of recordings from meetings of both projects to consider the ways that discussions about lived experiences and everyday lives demonstrate care through this dialogue. Using this analysis, we propose that care ethics can be useful in transforming relationships between older people and those working with them through the creation of hybrid spaces in which 'care-full deliberation' can happen. We argue that such reflective spaces can enable transformative dialogue about care and its importance to older people and offer a counterbalance to the procedurally driven environments in which much social work practice takes place and can support practice more attuned to the circumstances and concerns of older people.
Green, Amy E.; Miller, Elizabeth A.; Aarons, Gregory A.
Public sector mental health care providers are at high risk for burnout and emotional exhaustion which negatively affect job performance and client satisfaction with services. Few studies have examined ways to reduce these associations, but transformational leadership may have a positive effect. We examine the relationships between transformational leadership, emotional exhaustion, and turnover intention in a sample of 388 community mental health providers. Emotional exhaustion was positively...
Verderber, S; Grice, S; Gutentag, P
The stress management-wellness health care environment is emerging as a distinct facility type in the 1980s. Yet the idea is not a new one, with roots based in the Greek Asklepieon dating from 480 B.C. This and later Western transformations for health promotion embraced the therapeutic amenity inherent in meditation, solace and communality with nature based on the premise that the need for refuge from the stress inherent in one's daily life is deep-rooted in humans. A two-phase study is reported on wellness health care provider priorities, relative to the architectural features of stress-wellness centers. Representatives of 11 health care organizations responded to a telephone survey questionnaire, and 128 respondents completed a user needs questionnaire. Four major issues were addressed: image and appearance, location and setting, services provided and costs, and patterns of use. Convenience to one's place of work, a balanced mixture of clinical and nonclinical programs, a noninstitutional retreat-like environment, and membership cost structures were found to be major user considerations with respect to planning and design concepts for wellness health care environments. Directions for further research are discussed.
Campbell, Robert James
This article introduces health care managers to the theories and philosophies of John Kotter and William Bridges, 2 leaders in the evolving field of change management. For Kotter, change has both an emotional and situational component, and methods for managing each are expressed in his 8-step model (developing urgency, building a guiding team, creating a vision, communicating for buy-in, enabling action, creating short-term wins, don't let up, and making it stick). Bridges deals with change at a more granular, individual level, suggesting that change within a health care organization means that individuals must transition from one identity to a new identity when they are involved in a process of change. According to Bridges, transitions occur in 3 steps: endings, the neutral zone, and beginnings. The major steps and important concepts within the models of each are addressed, and examples are provided to demonstrate how health care managers can actualize the models within their health care organizations.
JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. INTRODUCTION disability from complications of pregnancy and. 1 child birth. MI in birth preparedness is. Birth preparedness by a couple ensures that indispensible in rural communities where patriarchy appropriate care ...
Jonsson, E.; Banta, H.D.
Health care in Sweden is a public sector responsibility and equity in access to care is quite important. The Swedish system is organized into several levels, with the Federation of County Councils at the top, and with regional, county, and local levels. In theory, the four hospital tiers developed
Watson, Jean; Foster, Roxie
This paper presents a proposed model: The Attending Nursing Caring Model (ANCM) as an exemplar for advancing and transforming nursing practice within a reflective, theoretical and evidence-based context. Watson's theory of human caring is used as a guide for integrating theory, evidence and advanced therapeutics in the area of children's pain. The ANCM is offered as a programme for renewing the profession and its professional practices of caring-healing arts and science, during an era of decline, shortages, and crises in care, safety, and hospital and health reform. The ANCM elevates contemporary nursing's caring values, relationships, therapeutics and responsibilities to a higher/deeper order of caring science and professionalism, intersecting with other professions, while sustaining the finest of its heritage and traditions of healing.
Sherertz, R J; Bassetti, S.; Bassetti-Wyss, B.
Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site infection by airborne dispersal. Outbreaks have been associated with skin colonization or viral upper respiratory tract infection in a phenomenon of airborne dispersal of Staphylococcus aureus called the "cloud" phenomenon. This review summarizes the data supporting the e...
Marasović Šušnjara, Ivana
Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.
Meskó, Bertalan; Drobni, Zsófia; Bényei, Éva; Gergely, Bence; Győrffy, Zsuzsanna
Under the term "digital health", advanced medical technologies, disruptive innovations and digital communication have gradually become inseparable from providing best practice healthcare. While the cost of treating chronic conditions is increasing and doctor shortages are imminent worldwide, the needed transformation in the structure of healthcare and medicine fails to catch up with the rapid progress of the medical technology industry. This transition is slowed down by strict regulations; the reluctance of stakeholders in healthcare to change; and ignoring the importance of cultural changes and the human factor in an increasingly technological world. With access and adoption of technology getting higher, the risk of patients primarily turning to an accessible, but unregulated technological solution for their health problem is likely to increase. In this paper, we discuss how the old paradigm of the paternalistic model of medicine is transforming into an equal level partnership between patients and professionals and how it is aided and augmented by disruptive technologies. We attempt to define what digital health means and how it affects the status quo of care and also the study design in implementing technological innovations into the practice of medicine.
Simms, Mark D.; Freundlich, Madelyn; Battistelli, Ellen S.; Kaufman, Neal D.
Describes the essential features of a health care system that can meet the special needs of children in out-of-home care. Discusses some of the major recent changes brought about by welfare and health care reform. Notes that it remains to be seen whether the quality of services will improve as a result of these reforms. (Author)
... Control Preventing infections can help the respiratory home care patient stay as healthy as possible. Hand-washing is the single most important thing for patients and caregivers to perform on a routine basis. Use a liquid soap and lots of warm running water. Work up a good lather and scrub for at ...
Chiang, Li-Chi; Liao, Mei-Nan
As clinical scientists on the interdisciplinary healthcare team, nurses use the art and science of current nursing knowledge to provide evidence-based healthcare to each patient and his/her family. Nurses not only comprise the largest contingent of medical personnel and provide 24-hour patient care but are also professional scientists that develop unique nursing knowledge through reflective practice. Five strategies for expanding the body of current evidence-based nursing scientific knowledge include: (1) reflecting empirically on the practice-service domain, (2) developing nursing knowledge using rigorous methodology, (3) emancipating nursing knowledge using innovative transformation, (4) using collaborative interdisciplinary healthcare that is based in patient-centered care, and (5) initiating innovative transformation in nursing education. Nurses are critical healthcare providers that make important contributions to today's healthcare system. Nursing scientists provide frontline, evidence-based transforming care that deserves to be respected and valued on an equal basis with the care and services that are provided by other medical personnel.
Grazier, Kyle L; Metzler, Bridget
Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.
Martin, Carmel M; Peterson, Chris
The purpose of this paper is to argue the importance of contemporary analysis of the modern social construction of chronicity--encapsulating the world views of the chronically ill, and the medical and health system constructions of chronic disease, through the nature of care for chronic conditions. It is argued that chronic diseases are themselves, socially constructed, despite widely accepted disease classification systems. Thus, there is a need to examine how different ideas have permeated our clinical and health system developments and their social context and vice versa. We examine historical ideas, theory and evidence about the tensions in social construction of chronic illness by those afflicted and the responses of society, the medical and health professions and increasingly the public and private institutions that shape health care. This is with the background of major differences in the two cultures that create knowledge: those based upon argument and intellectual logic--hermeneutic, and those based upon 'objectivist' empirical science, often called heuristic. Evidence-based medicine (EBM) is the flagship of disease management, increasingly narrative-based medicine and other similar genres are becoming the pragmatic face of social constructions, yet sit in juxtaposition without synthesis. A third culture has emerged of scientific intellectuals who straddle these cultures and in health care their public face is 'mixed methods'. Recent cases of modern ideas about improving chronic care were reviewed. We found that despite developments of social theory, the world view of the chronically ill exerts small influence in health system redesign, apparently dominated by chronic disease models. Confusion remains within health system reforms as to the social construction of chronicity--chronic disease, chronic condition or chronic illness and chronic care transformations. The role of Primary Care remains ambiguous straddling disease and illness. Radical redesign of
Dubouloz, Claire-Jehanne; King, Judy; Paterson, Barbara; Ashe, Brenda; Chevrier, Jacques; Moldoveanu, Mirela
The objective of the research was to construct a conceptual framework that explains the process of personal transformation within a primary care context for people living with chronic illnesses. A literature search of articles published from 1990 to 2007 in CINAHL, ERIC, Healthstar, MEDLINE, PsycINFO, dissertation abstracts and SocINFO databases, was conducted to identify qualitative research studies investigating personal change in chronic illness or disability. Five hundred and fifty-six articles were identified; the researchers conducted a metasynthesis of a subgroup of these articles whose focus was on transformation in primary care (n = 5). The metasynthesis project presents a model of the conceptualizations of transformation. Transformation in chronic illness is presented as a process of learning about self and the chronic illness in an iterative and continually changing manner. The primary care context has its greatest influence on critical reflection, which occurs in the first phase (initial response). This model illustrates the complex processes that occur for someone living with a chronic illness. Health practitioners who understand why and how people transform in living with chronic illnesses will be able to apply this model in determining people's needs and how to assist people during the transformative process.
... in medical offices or in the dialysis unit. Nephrology Nurse Nephrology nurses are licensed, registered nurses who ... nutritional intake to ensure the patient's optimal health. Nephrology Social Worker Most nephrology social workers have a ...
Buchanan, Larry M.
It is widely recognized throughout the health care industry that the United States leads the world in health care spending per capita. However, the chilling dose of reality for American health care consumers is that for all of their spending, the World Health Organization ranks the country's health care system 37th in overall performance--right…
Zierler, Brenda K; Abu-Rish Blakeney, Erin; O'Brien, Kevin D; Teams, Ipcp Heart Failure
Interprofessional collaborative practice (IPCP) approaches to health care are increasingly recognized as necessary to achieve the Triple Aim-improved health of the population, improved patient care experience, and improved affordability of care. This paper introduces and provides an overview of an interprofessional intervention to improve a healthcare team, healthcare system, and patient outcomes for hospitalized patients with heart failure. In this paper, we describe the overall project resulting from a workforce training grant and the proposed series of future papers resulting from the interprofessional intervention. Collectively, these papers will describe the results of a unique IPCP approach on team, system, and patient outcomes as well as describe and compare organizational and leadership traits that affect collaborative practice. Our hope is that the intervention approaches, evaluation results, and lessons learned described in these papers will help further the efforts to spread IPCP approaches to transforming health care.
... Living Listen Español Text Size Email Print Share Mental Health Care: Who's Who Page Content Article Body Psychiatrist: ... degree in psychology, counseling or a related field. Mental Health Counselor: Master’s degree and several years of supervised ...
the children didnot receive BCG vaccine while spiritual homes was the pattern in 6.9 households. 22.9% did not receive measles vaccine. A total of 63 under-five deaths were reported in 53. Table VI shows the health-seeking behaviour of. 6. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL.
This podcast will educate health care providers on diagnosing babesiosis and providing patients at risk with tick bite prevention messages. Created: 4/25/2012 by Center for Global Health, Division of Parasitic Diseases and Malaria. Date Released: 4/25/2012.
Full Text Available Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.
Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC) practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.
Lindgren, Carolyn L; Elie, Leslie G; Vidal, Elizabeth C; Vasserman, Alex
In reaching the goal for standardized, quality care, a not-for-profit healthcare system consisting of seven institutional entities is transforming nursing practice guidelines, patient care workflow, and patient documents into electronic, online, real-time modalities for use across departments and all healthcare delivery entities of the system. Organizational structure and a strategic plan were developed for the 2-year Clinical Transformation Project. The Siemens Patient Care Document System was adopted and adapted to the hospitals' documentation and information needs. Two fast-track sessions of more than 100 nurses and representatives from other health disciplines were held to standardize assessments, histories, care protocols, and interdisciplinary plans of care for the top 10 diagnostic regulatory groups. Education needs of the users were addressed. After the first year, a productive, functional system is evidenced. For example, the bar-coded Medication Administration Check System is in full use on the clinical units of one of the hospitals, and the other institutional entities are at substantial stages of implementation of Patient Care Documentation System. The project requires significant allocation of personnel and financial resources for a highly functional informatics system that will transform clinical care. The project exemplifies four of the Magnet ideals and serves as a model for others who may be deciding about launching a similar endeavor.
Svendsen, Gunnar Lind Haase; Jensen, Marit Vatn
This literature study focuses on possible links between access to health services and migration in rural areas. Why do people move to or from rural areas or why do they stay? What determines where people settle? And, in this context, do local health care services play an important or minor role......, or no role at all? First, the paper reports on key findings from rural migration studies, in order to shed light on two migration trends: urbanization and counter-urbanization. Then we take a closer look on settlement preferences in rural areas, including the impact of health care facilities. Finally, we end...
National Environmental Education & Training Foundation, 2012
This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on…
Araújo, Patricia Sodré; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair
To characterize the activities of clinical nature developed by pharmacists in basic health units and their participation in educational activities aiming at health promotion. This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional and exploratory study, of evaluative nature, consisting of a survey of information in a representative sample of cities, stratified by the Brazilian regions that constitute domains of study, and a subsample of primary health care services. The interviewed pharmacists (n=285) were responsible for the delivery of medicines and were interviewed in person with the use of a script. The characterization of the activities of clinical nature was based on information from pharmacists who declared to perform them, and on participation in educational activities aiming at health promotion, according to information from all pharmacists. The results are presented in frequency and their 95% confidence intervals. From the interviewed subjects, 21.3% said they perform activities of clinical nature. Of these, more than 80% considered them very important; the majority does not dispose of specific places to perform them, which hinders privacy and confidentiality in these activities. The main denominations were "pharmaceutical guidance" and "pharmaceutical care." The registration of activities is mainly made in the users' medical records, computerized system, and in a specific document filed at the pharmacy, impairing the circulation of information among professionals. Most pharmacists performed these activities mainly along with physicians and nurses; 24.7% rarely participated in meetings with the health team, and 19.7% have never participated. Activities of clinical nature performed by pharmacists in Brazil are still incipient. The difficulties found point out
Halfon, Neal; And Others
Outlines access to health care for children in out-of-home care under current law, reviews how health care access for these children would be affected by President Clinton's health care reform initiative, and proposes additional measures that could be considered to improve access and service coordination for children in the child welfare system.…
Bitton, Asaf; Ellner, Andrew; Pabo, Erika; Stout, Somava; Sugarman, Jonathan R; Sevin, Cory; Goodell, Kristen; Bassett, Jill S; Phillips, Russell S
Academic medical centers (AMCs) need new approaches to delivering higher-quality care at lower costs, and engaging trainees in the work of high-functioning primary care practices. In 2012, the Harvard Medical School Center for Primary Care, in partnership with with local AMCs, established an Academic Innovations Collaborative (AIC) with the goal of transforming primary care education and practice. This novel two-year learning collaborative consisted of hospital- and community-based primary care teaching practices, committed to building highly functional teams, managing populations, and engaging patients. The AIC built on models developed by Qualis Health and the Institute for Healthcare Improvement, optimized for the local AMC context. Foundational elements included leadership engagement and development, application of rapid-cycle process improvement, and the creation of teams to care for defined patient populations. Nineteen practices across six AMCs participated, with nearly 260,000 patients and 450 resident learners. The collaborative offered three 1.5-day learning sessions each year featuring shared learning, practice coaches, and improvement measures, along with monthly data reporting, webinars, and site visits. Validated self-reports by transformation teams showed that practices made substantial improvement across all areas of change. Important factors for success included leadership development, practice-level resources, and engaging patients and trainees. The AIC model shows promise as a path for AMCs to catalyze health system transformation through primary care improvement. In addition to further evaluating the impact of practice transformation, expansion will require support from AMCs and payers, and the application of similar approaches on a broader scale.
Gilfillan, Richard J; Tomcavage, Janet; Rosenthal, Meredith B; Davis, Duane E; Graham, Jove; Roy, Jason A; Pierdon, Steven B; Bloom, Frederick J; Graf, Thomas R; Goldman, Roy; Weikel, Karena M; Hamory, Bruce H; Paulus, Ronald A; Steele, Glen D
The primary care medical home has been promoted to integrate and improve patient care while reducing healthcare spending, but with little formal study of the model or evidence of its efficacy. ProvenHealth Navigator (PHN), an intensive multidimensional medical home model that addresses care delivery and financing, was introduced into 11 different primary care practices. The goals were to improve the quality, efficiency, and patient experience of care. To evaluate the ability of a medical home model to improve the efficiency of care for Medicare beneficiaries. Observational study using regression modeling based on preintervention and postintervention data and a propensity-selected control cohort. Four years of claims data for Medicare patients at 11 intervention sites and 75 control groups were analyzed to compute hospital admission and readmission rates, and the total cost of care. Regression modeling was used to establish predicted rates and costs in the absence of the intervention. Actual results were compared with predicted results to compute changes attributable to the PHN model. ProvenHealth Navigator was associated with an 18% (P Investing in the capabilities of primary care practices to serve as medical homes may increase healthcare value by improving the efficiency of care. This study demonstrates that the PHN model is capable of significantly reducing admissions and readmissions for Medicare Advantage members.
Young, D W
Many Western European countries are moving toward privatization of their health care systems. The United States' health care system, since it is almost entirely privatized, is therefore worthy of study. Doing so raises several questions. How is privatization being managed in the US? How could its management be improved? What management lessons must be kept in mind if it is to be used effectively? What potential pitfalls should European countries consider as they move toward greater privatization? With operating costs, European countries must avoid the mistakes that have led to dramatic increases in annual health care costs in the US, simultaneous with reductions in access and quality. Doing so requires designing systems that promote hospital behavior consistent with a country's health objectives. With capital costs, an approach must be designed that allows policy-makers to work closely with both managers and physicians in order to make strategically sound choices about access and quality. Such an approach will require physicians to incorporate their clinical judgments into community standards of care, and to adopt a regional (rather than an institutional or personal) perspective in the determination of any incremental capital expenditures. By making regulation proactive and strategic, rather than punitive, health policymakers in Western Europe can achieve the best privatization has to offer without feeling the sting of its unintended consequences. In so doing they can help to move their health systems toward achieving the multiple and illusive goals of access, quality and reasonable cost.
telemonitoring . In emergency cases where immediate medical treatment is the issue, recent studies conclude that early and specialized pre-hospital patient ...Lama, J Vila: “Intelligent Telemonitoring of Critical Care Patients ”, IEEE EMB Mag, Vol 18, No 4, pp 80-88, Jul/Aug 1999.  Strode S, Gustke S...Abstract- In this study we present a multipurpose health care telemedicine system, which can be used for emergency or patient monitoring cases
This podcast is based on the November, 2010 CDC Vital Signs report which indicates that more than one in four adults 18-64 years old (about 50 million) report being uninsured for at least part of the past 12 months, and focuses on the growing number of middle-income adults and those with a chronic illness or disability who have no health insurance. Created: 11/9/2010 by Centers for Disease Control and Prevention (CDC). Date Released: 11/9/2010.
Sahoo, Sanjeeb K
Nanomedicine: Emerging Field of Nanotechnology to Human HealthNanomedicines: Impacts in Ocular Delivery and TargetingImmuno-Nanosystems to CNS Pathologies: State of the Art PEGylated Zinc Protoporphyrin: A Micelle-Forming Polymeric Drug for Cancer TherapyORMOSIL Nanoparticles: Nanomedicine Approach for Drug/Gene Delivery to the BrainMagnetic Nanoparticles: A Versatile System for Therapeutic and Imaging SystemNanobiotechnology: A New Generation of Biomedicine Application of Nanotechnology-Based Drug Delivery and Targeting to LungsAptamers and Nanomedicine in C
The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.
... Management Education & Events Advocacy For Patients About ACOG Good Health Before Pregnancy: Preconception Care Home For Patients Search ... Pregnancy: Preconception Care FAQ056, April 2017 PDF Format Good Health Before Pregnancy: Preconception Care Pregnancy What is a ...
Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special ... for and what to ask will help you choose an organization that provides safe, quality care, treatment ...
Pfaff, H; Pförtner, T-K
Social inequalities in health and health care services represent issues of major concern. Findings in this area reveal inequalities in health and health care indicating disadvantages for individuals with a low socioeconomic background. Although the health care system plays a marginal role in the explanation of inequalities in health, health services research can be an important part in the development of equal health opportunities. The current article describes the causal associations between social inequalities, health inequalities and the health care service. Health services research can make a contribution to increasing equal opportunities in health and health care service. Against this background, we discuss the existing potential and need of research in the area of health services. © Georg Thieme Verlag KG Stuttgart · New York.
Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio
OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949
Heller, Kathryn Wolff; Avant, Mary Jane Thompson
Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…
This is an empirical study of 7 communities among the O-kun Yoruba of Ijumu, Kogi State, Nigeria. The general objective of the study was to investigate the prioritizing pattern of the various Primary Health Care services (PHC) in the study area. Data for the study were generated mainly through multi-stage sampling ...
Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre
The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues...... through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries...... of prevention and public health? What role do citizen-doctors of chiropractic have in organizing community action on health-related matters? How can our future chiropractic graduates become socially responsible agents of change?...
Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey
The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the
Addresses the crisis in health care, considering costs, lack of access, and system ineffectiveness. Reviews "Setting Relationships Right," the Catholic Health Association's proposal for health care reform. Advocates educators' awareness of children's health needs and health care reform issues and support for the Every Fifth Child Act of…
McKenna, Brian; Furness, Trentham; Dhital, Deepa; Park, Malcolm; Connally, Fiona
As custodial mental health services are beginning to adopt a recovery-oriented model of care, it is imperative that successes in the transformation to recovery are captured. The aim of this illustrative case study was to describe the organizational procedure that enabled the systematic transformation of a custodial mental health service to a service with a self-professed recovery orientation as its model of service delivery. One-to-one interviews with key stakeholders and a document analysis were completed to thoroughly describe the transformation of the service. Four major themes arose from the data: (a) "We had this whole paradigm shift that needed to happen;" (b) "Think recovery," the development of a manualized guide; (c) "Stepping out my recovery;" adaptation of the service guide to the secure care context; and (d) developing the culture. The "developing the culture" major theme was subcategorized to consist of (a) the right people, (b) education, (c) reflective learning, and (d) leadership. The themes provided insights to assist mental health nurses to understand the processes involved in systems transformation. However, the major successes of the service, although only recently evaluated, commenced over a decade ago and yet continue to evolve.
Le Var, Rita M. H.
Nurses and health care professionals must be prepared for transcultural health care because society is becoming increasingly multicultural and current health services are not meeting the needs of minority ethnic groups in Britain. (SK)
Willberg, A; Heger, R
This paper reports in detail on a project of Integrated Health Care in cardiology at Potsdam, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.
Wagner, H C; Fleming, D; Mangold, W G; LaForge, R W
Building relationships with patients is critical to the success of many health care organizations. The authors profile the relationship marketing program for a hospital's cardiac center and discuss the key strategic aspects that account for its success: a focus on a specific hospital service, an integrated marketing communication strategy, a specially designed database, and the continuous tracking of results.
Centres in Sabon Gari Local Government Area, Kaduna State Nigeria. journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. 1. 1. 1. M.B Sufiyan , A.A Umar , A. Shugaba . 1Department of Community Medicine, Ahmadu Bello University, Zaria. KEYWORDS. Assessment,. Client satisfaction, ANC,. PHC centers.
Handelsman, L; Speiser, M; Maltz, A; Kirpalani, S
Bankruptcy is an event that is often considered a business' worst nightmare. Debt, lawyers, and the U.S. government can lead to the eventual destruction of a business. This article shows how declaring bankruptcy can be a helpful instrument in continuing a successful venture in the health care marketplace.
Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi
In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...
Somasundaram, D. J.; van de Put, W. A.
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization. PMID:10212521
Somasundaram, D. J.; van de Put, W. A.
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization.
Connor, L R
Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management.
to eat together and lying on the same bed with ocular have far reaching implications in terms of cancers patients. management, prognosis and mortality of ocular cancer. Such individuals may not access available. Further analysis indicates that respondents'. 3,9 education, gender and marital status have no health care ...
This paper reports in detail on a project of Integrated Health Care in cardiology at Nuremberg, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.
Improving skilled attendants at birth: Experience in a primary health care facility in Rivers State, South-South Nigeria. 1. 2. Ordinioha B. , Seiyefa B. 1Community Medicine Department, University of Port Harcourt Teaching Hospital, Port Harcourt. 2Department of Family Medicine, Niger Delta University Teaching Hospital, ...
Artiklen har fokus på undervisning, planlægning, udvikling og evaluering af et internationalt tværfagligt valgfag Intercultural Health Care and Welfare, der udbydes på Det Sundhedsfaglige og Teknologiske Fakultet på Professionshøjskolen Metropol. Ifølge den tysk-amerikanske professor Iris Varner og...
U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...
Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical sc...
Mansoor Akhtar; James Norbert Casha; Julia Ronder; Mohamed Sakel; Catherine Wight; Kim Manley
Background: Leadership development impacts on quality of care and on workplace cultures for staff. Clinical leadership embracing transformational and other collective leadership approaches is a key enabler for developing effective workplace cultures at the micro-systems level. Following the development of a shared purpose and values framework, an internal interprofessional clinical leadership programme was set up to grow a critical community of transformational leaders across one NHS organisa...
Robinson, James C
The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations.
Kern, T; Kohnen, T
Although many health care reforms have been enacted in the last few years in Germany, many of the key points in the current social health care system have been retained from former times. All those introductions for an effective health care system from the last 150 years beginning with mandatory guild membership via Bismarck's social laws to the modern health care systems in Germany with the current problems of financing the heavy burden in the German budget are reported. Data and facts on the current health care system are provided. In the following two articles of this series ambulatory and inpatient treatment in the light of economic aspects of health care are reported.
Health care technology has become an increasingly visible issue in many countries, primarily because of the rising costs of health care. In addition, many questions concerning quality of care are being raised. Health care technology assessment has been seen as an aid in addressing questions
Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in health care practices raise several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in health care practices as replacements of human care. I analyse them as demands for felt care, good care, private care, and real care. I argue that although these objections cannot stand as good reasons for a general and a priori rejection of AI assistive technolog...
Orlando, Rocco; Haytaian, Marcia
The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.
... html To Your Health: NLM update Transcript Four health care challenges : 10/10/2017 To use the sharing ... to follow up on weekly topics. The U.S. health care delivery system needs to address four challenges in ...
Full Text Available The world population reached 7 billion in 2012, which is 6 billion more than in 1800. This remarkable population growth is the result of several factors like advances in the medical, technological and public health systems resulting in the control and treatment of communicable diseases, the control of pandemics, the end of large-scale wars, improvements in living conditions and the revolutions in the field of agriculture. Because of all these factors, there has been a considerable improvement in the life expectancy of human beings. There is also an alarming reduction in fertility rates. The combination of declining fertility rate and augmented life expectancies has led to a change in the demographics of the population with the strata of older individuals growing faster than the younger individuals. The aging of populations is poised to become the next global public health challenge. Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanization, modernization, globalization, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic non-infective conditions. Health systems need to find effective strategies to extend health care and to respond to the needs of older adults. This review highlights the pathophysiology of aging, biological and physiological changes, impact of aging on health, epidemiological transitions, multi-morbidity in elderly and challenges for health care system.
Crall, James J
National and state-level evidence has documented ongoing disparities in children's health and utilization of oral health care services, prompting a re-examination of factors associated with poor oral health and low use of oral health services. These efforts have yielded a wide array of proposals for improving children's oral health and oral health care delivery. This paper offers a perspective on the current context of efforts to improve children's oral health and oral health care delivery.
care reform legislation—the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA...Estimated Costs for Compliance Patient Protection and Affordable Care Act (PPACA) and Health Care and Education Reconciliation Act of 2010 (HCERA...including inpatient hospitals, home health agencies, nursing homes, hospice providers, psychiatric hospitals, long-term care hospitals, inpatient
According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…
Bayer, R; Callahan, D; Caplan, A L; Jennings, B
The demands of equity and efficiency require a program of universal health insurance in the United States through which all workers will be provided by their employers with health insurance for themselves and their dependents, unemployment will no longer result in the loss of health insurance protection, and federal standards for Medicaid eligibility will be instituted. Issues raised by the assessment of insurance coverage and establishment of uniform standards are discussed within the context of the ethical foundations of medical necessity, schemes for sharing the burden of cost, and the conflict between technological advances and the limitation of resources. Cost containment measures now most prominently on the public agenda represent an unfortunate trend toward exacerbating inequalities by making the patient the main cost container. Moral priority must be given to remedying the patterns of inequality that characterize the American health care system.
Homer, Charles J; Baron, Richard J
Becoming a medical home is a radical change, requiring both a new mental model for primary care and the skills and resources to accomplish it. Although numerous reports indicate practice change is feasible--particularly with technical support and either insulation from or alignment with financial incentives--sustained transformation appears difficult. We identified the following critical success factors: leadership, financial resources, personal and organizational relationships, engagement with patients and families, competence in management, improvement methods and coaching, health information technology properly applied, care coordination support, and staff development. Each factor raises researchable questions about what policies can facilitate achieving success so that transformation becomes mainstream rather than the province of the innovative few.
Because of the importance of grassroots social movements, or “change from below,” in the history of US reform, the relationship between social movements and demands for universal health care is a critical one. National health reform campaigns in the 20th century were initiated and run by elites more concerned with defending against attacks from interest groups than with popular mobilization, and grassroots reformers in the labor, civil rights, feminist, and AIDS activist movements have concentrated more on immediate and incremental changes than on transforming the health care system itself. However, grassroots health care demands have also contained the seeds of a wider critique of the American health care system, leading some movements to adopt calls for universal coverage. PMID:12511390
Business school curricula have traditionally emphasized functional skills for people who will work in functional departments and general management skills for people who will organize interdepartmental work. Recently, some business schools have begun to develop programs that teach cross-functional work and team skills to functional specialists. Students educated in such programs will be well prepared to meet the new challenges that health care organizations will face.
The five leading issues identified, in order of importance, were 1. The need for treatment outcome and efficacy data. 2. The need for changes in clinical and academic preparation of entry-level practitioners. 3. The lack of inclusion or use of services for communication and related disorders in public and private health care programs. 4. The need for greater professional autonomy within the health care system. 5. The need to improve services to underserved populations with communication and related disorders. This report was forwarded to key National Office staff and appropriate ASHA boards, councils, and committees for the purposes of determining its feasibility and developing a national plan for action. The feasibility and action plan will detail completed, ongoing and future activities of the Association related to each issue, recommendation, and strategy. Periodic review of the actions taken and progress achieved will be monitored by the Executive Board, other appropriate boards and councils, and designated National Office staff. The plan represents a progressive view of needed change for the professions of speech-language pathology and audiology within the context of the broader health care delivery system.
tion that is community-oriented (Mullan et al., 2011). These recommendations move health professionals' edu- cation from an isolated learning phenomenon facilitated by educators in a classroom or health facility, to being a broader and more interactive process in which society and communities play a key role. Teaching ...
Programs and concepts included in the Patient Protection and Affordable Care Act of 2010 are expected to transform health care in the United States from a volume-based health system to a value-based health system with increased emphasis on prevention and health promotion. The Triple Aim, a framework set forth by the Institute for Healthcare Improvement, focuses on improving the health care experience, the health of populations, and the affordability of care. This article describes telehealth as an integral component in achieving the Triple Aim of health care and discusses implications for occupational therapy practitioners. Copyright © 2015 by the American Occupational Therapy Association, Inc.
U.S. Department of Health & Human Services — The Affordable Care Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid...
Piper, Llewellyn E
Passion in today's health care leaders is essential as health care organizations face increasing demands for survival. Leaders in health care have been educated, selected, promoted, and retained based on their analytical and creativity skills. Today's health care leaders must also have emotional intelligence. Emotional intelligence is primal for passion. Emotional intelligence, which leads to passion, is crucial to the survivability of today's health care organizations. In order for health care organizations to go from good to great, the leader must inspire followers through passion. This article encourages health care leaders to gain awareness of emotional intelligence and to use emotional intelligence as part of their leadership to inspire passion. Through passion, leaders and followers become more motivated to accomplish the health care mission of serving others.
... consider, including What your insurance covers Whether a health care provider or service is accredited The location of a service Hours ... ll find information to help you choose a health care provider or service.
This article discusses ways to lesson the restrictions on health development in sub-Saharan Africa caused by limited public health budgets. Health improvements can be funded by the implementation of health insurance, the use of foreign aid, the raising of taxes, the reallocation of public money, and direct contributions by users or households either in the form of charges for services received or prepayments for future services. Community financing, i.e. the direct financing of health care by households in villages or distinct urban communities, is seen as preferable to a national or regional plan. When community financing is chosen, a choice must then be made between direct payment, fee-for-service, and prepayment (insurance) systems. The 3 systems, using the example of an essential drugs program, are described. Theoretically, with direct payment the government receives full cost recovery, and the patients receive the drugs they need, thereby improving their health. Of course the poor may not be able to purchase the drugs, therefore a subsidy system must be worked out at the community level. Fee-for-service means charging for a consultation or course of treatment, including drugs. A sliding scale of fees or discounts for certain types of consultations (e.g. pre-and post natal) can be used. In fee-for-service the risk is shared; because the cost of drugs is financed by the fees, those who receive costly treatments are subsidized by those whose treatments are relatively inexpensive. With prepayment or health insurance the risk of illness is shifted from the patient to the insurance firm or state. 2 issues make insurance plans hard to implement. When patients are covered by insurance, they may demand "too much" medical care (moral hazard) and thus premiums may be too small to cover treatment costs. On the other hand, people in low-risk groups may be unwilling to pay a higher premium, thus leading to adverse selection. Eventually, premiums may rise to the point where
Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.
Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of
Cutler, David M.
Health care is one of the economy's biggest industries, so it is natural that the health care industry should play some role in the teaching of introductory economics. There are many ways that health care can appear in such a context: in the teaching of microeconomics, as a macroeconomic issue, to learn about social welfare, and even to learn how…
Brink-Muinen, A. van den
Differences are investigated between female practice populations of female general practitioners providing women's health care and of women and men general practitioners providing regular health care. Women's health care in the Netherlands is provided in the general practice "Aletta" and is based
Padrosa, Josep Maria; Guarga, Àlex; Brosa, Francesc; Jiménez, Josep; Robert, Roger
The changes taking place in western countries require health systems to adapt to the public's evolving needs and expectations. The healthcare model in Catalonia is undergoing significant transformation in order to provide an adequate response to this new situation while ensuring the system's sustainability in the current climate of economic crisis. This transformation is based on converting the current disease-centred model which is fragmented into different levels, to a more patient-centred integrated and territorial care model that promotes the use of a shared network of the different specialities, the professionals, resources and levels of care, entering into territorial agreements and pacts which stipulate joint goals or objectives. The changes the Catalan Health Service (CatSalut) has undergone are principally focused on increasing resolution capacity of the primary level of care, eliminating differences in clinical practice, evolving towards more surgery-centred hospitals, promoting alternatives to conventional hospitalization, developing remote care models, concentrating and organizing highly complex care into different sectors at a territorial level and designing specific health codes in response to health emergencies. The purpose of these initiatives is to improve the effectiveness, quality, safety and efficiency of the system, ensuring equal access for the public to these services and ensuring a territorial balance. These changes should be facilitated and promoted using several different approaches, including implementing shared access to clinical history case files, the new model of results-based contracting and payment, territorial agreements, alliances between centres, harnessing the potential of information and communications technology and evaluation of results. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Health professionals' education is undergoing enormous transformation internationally and also in Rwanda. We present the contribution of a Social and Community Medicine program at the University of Rwanda to this new era of community oriented, people centred and socially accountable health professionals' education.
Ong, Toan C; Kahn, Michael G; Kwan, Bethany M; Yamashita, Traci; Brandt, Elias; Hosokawa, Patrick; Uhrich, Chris; Schilling, Lisa M
Electronic health records (EHRs) contain detailed clinical data stored in proprietary formats with non-standard codes and structures. Participating in multi-site clinical research networks requires EHR data to be restructured and transformed into a common format and standard terminologies, and optimally linked to other data sources. The expertise and scalable solutions needed to transform data to conform to network requirements are beyond the scope of many health care organizations and there is a need for practical tools that lower the barriers of data contribution to clinical research networks. We designed and implemented a health data transformation and loading approach, which we refer to as Dynamic ETL (Extraction, Transformation and Loading) (D-ETL), that automates part of the process through use of scalable, reusable and customizable code, while retaining manual aspects of the process that requires knowledge of complex coding syntax. This approach provides the flexibility required for the ETL of heterogeneous data, variations in semantic expertise, and transparency of transformation logic that are essential to implement ETL conventions across clinical research sharing networks. Processing workflows are directed by the ETL specifications guideline, developed by ETL designers with extensive knowledge of the structure and semantics of health data (i.e., "health data domain experts") and target common data model. D-ETL was implemented to perform ETL operations that load data from various sources with different database schema structures into the Observational Medical Outcome Partnership (OMOP) common data model. The results showed that ETL rule composition methods and the D-ETL engine offer a scalable solution for health data transformation via automatic query generation to harmonize source datasets. D-ETL supports a flexible and transparent process to transform and load health data into a target data model. This approach offers a solution that lowers technical
Nisselle, Amy; Green, Julie; Scrimshaw, Chantel
Purpose: Chronic health conditions can cause children extended school absences, creating significant barriers for continued education. Out-of-school learning environments, such as hospitals, provide opportunities to maintain children's learning identities during school absences. This paper seeks to present an example of hospital-based teaching and…
Teaching and Learning Strategies in iSOCO. Health professional educators in Rwanda are joining forces in the attempt to ensure a coherent and account- able education of the future workforce. One component of this process is the development of a Social and Com- munity Medicine training program (iSOCO), from which.
The Mental Health Care Act 17 of 2002(MHCA) was promulgated in 2004. It has been hailed as one of the most progressive pieces of mental health legislation. A true measure of its merit is the degree to which it has transformed mental health services and in particular improved the quality of care. This paper will describe ...
Wees, P.J. van der; Zaslavsky, A.M.; Ayanian, J.Z.
CONTEXT: Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts
Kimmey, James R.
A discussion of the implications of health care reform for academic health centers (a complex of institutions which educate health professionals) looks at problems in the current system, the role of academic health centers in the current system, financial pressures, revenue sources other than patient care, impact on health research, and human…
The main objective was to estimate sector wide disease speciﬁc cost of health care intervention at health ... [Afr J. Health Sci. 2002; 9: 69-79]. Introduction interest in the costs of health care interventions derives from the desire to undertake economic evaluation that are input in health .... accounting procedure. It is based on ...
Deutsch, Stephanie Anne; Fortin, Kristine
Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed. Copyright © 2015 Mosby, Inc. All rights reserved.
Bump, Jesse B; Powers Sparkes, Susan
Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have reshaped the health system. Understanding the political economy of this process is important for the future of Universal Health Coverage (UHC) in Turkey, and also for many other countries and the development agencies that assist them. This report analyzes the historical context and complex political economy challenges of the reform. Our findings are ...
Context: Health care at the primary level is accepted as the model for delivering basic health care to low income populations especially in developing countries such as Nigeria. Despite all the efforts and strategiesadapted in Nigeria, there is still high level of morbidity and mortality from the diseases primary health care ...
Irwin, Charles E., Jr., Ed.; And Others
Health care reform represents a major step toward achieving the goal of improved preventive and primary care services for all Americans, including children and adolescents. Adolescence is a unique developmental age district from both childhood and adulthood with special vulnerabilities, health concerns, and barriers to accessing health care. It is…
Background: data from different studies showed health care behaviour and estimated per capita health care expenditure for the general population, but the specific data for infants at different levels of care are lacking. The objectives of this study were to describe mothers' health service utilization during pregnancy and ...
Maria Cristina Barbaro
Full Text Available OBJECTIVE: evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC guidelines. METHOD: quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes. RESULTS: for all the participating units, the attribute Access scored =6.6; the attributes Longitudinality, Coordination (integration of care, Coordination (information systems and Integrality scored =6.6, and the Essential Score =6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored =6.6, the others attributes scored =6.6; however, in the basic units, the Essential Score was =6.6 and, in the family health units, =6.6. CONCLUSION: expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.
Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja
The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services.
Tomkins, Andrew; Duff, Jean; Fitzgibbon, Atallah; Karam, Azza; Mills, Edward J; Munnings, Keith; Smith, Sally; Seshadri, Shreelata Rao; Steinberg, Avraham; Vitillo, Robert; Yugi, Philemon
Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care. Copyright © 2015 Elsevier Ltd. All rights reserved.
M.Cur. (Nursing Administration) With the Declaration of Alma Ata in September, 1978, a new era in health care delivery, the primary health care era with its slogan of "health for all by the year 2000' dawned. Much thought had to be put into new legislation and reorganizing of health services in South Africa. Soweto, devastated by riots in 1976, suffered badly when all health care services collapsed. Out of this crisis was born a primary health care service that provides Soweto with prevent...
Corrigan, P W; Garman, A N
Many treatments for persons with severe mental illness are provided by mental health teams. Team members work better when led by effective leaders. Research conducted by organizational psychologists, and validated on mental health teams, have identified a variety of skills that are useful for these leaders. Bass (1990, 1997) identified two sets of especially important skills related to transformational and transactional leadership. Leaders using transformational skills help team members to view their work from more elevated perspectives and develop innovative ways to deal with work-related problems. Skills related to transformational leadership promote inspiration, intellectual stimulation, individual consideration, participative decision making, and elective delegation. Mental health and rehabilitation teams must not only develop creative and innovative programs, they must maintain them over time as a series of leader-team member transactions. Transactional leadership skills include goal-setting, feedback, and reinforcement strategies which help team members maintain effective programs.
Sorrell, Jeanne M
Health care was an important issue for both the Obama and McCain election campaigns. Now that Barack Obama is poised to serve as the 44th President of the United States, many health care providers are focused on what Obama's administration will mean for new health care initiatives. This article focuses specifically on aspects of the Obama and Biden health care plan that affects mental health care for older adults.
This paper explores the dynamics of health and health care in Cuba during a period of severe crisis by placing it within its economic, social, and political context using a comparative historical approach. It outlines Cuban achievements in health care as a consequence of the socialist transformations since 1959, noting the full commitment by the Cuban state, the planned economy, mass participation, and a self-critical, working class perspective as crucial factors. The roles of two external factors, the U.S. economic embargo and the Council of Mutual Economic Cooperation (CMEA), are explored in shaping the Cuban society and economy, including its health care system. It is argued that the former has hindered health efforts in Cuba. The role of the latter is more complex. While the CMEA was an important source for economic growth, Cuban relations with the Soviet bloc had a damaging effect on the development of socialism in Cuba. The adoption of the Soviet model of economic development fostered bureaucracy and demoralization of Cuban workers. As such, it contributed to two internal factors that have undermined further social progress including in health care: low productivity of labor and the growth of bureaucracy. While the health care system is still consistently supported by public policy and its structure is sound, economic crisis undermines its material and moral foundations and threatens its achievements. The future of the current Cuban health care system is intertwined with the potentials for its socialist development.
J.J.M. Barendregt (Jan); L.G.A. Bonneux (Luc); P.J. van der Maas (Paul)
textabstractBACKGROUND: Although smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs
U.S. Department of Health & Human Services — The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A...
... Groups Health and Wellness Outreach Materials Posters Safety Gun Safety Medication Safety Reproductive Health Healthy Pregnancy Preconception ... where specific authority is given to VA by law. Contact your nearest VA health care facility (found ...
Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes
.... The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in global health...
Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical science, it now may be adversely affecting value. Problem-oriented care is clearly one of the drivers of rising costs and it could be adversely affecting the quality of care, depending upon how quality is defined. If we redefined health in terms of patient-centered goals, health care could be focused more directly on meaningful outcomes, reducing the number of irrelevant tests and treatments. Greater emphasis would be placed on prevention, meaningful activities, advance directives and personal growth and development. The role of patients within clinician-patient relationships would be elevated, strengthening therapeutic relationships. Reframing health in terms of health-related goals and directing the health care system to help people achieve them, could both improve quality and reduce costs. In the process, it could also make health care less mechanical and more humane.
Bystedt, Maria; Eriksson, Maria; Wilde-Larsson, Bodil
To describe how registered nurses (RNs) perceive delegation to unlicensed personnel (UP) in a municipal healthcare context in Sweden. Within municipal health care RNs often delegate tasks to UP. The latter have practical training, but lack formal competence. Twelve RNs were interviewed and the material was analysed using a phenomenographic approach. Owing to a shortage of RNs, delegation is seen as a prerequisite for a functioning organization. This necessity also involves a number of perceived contradictions in three areas: (1) the work situation of RNs - facilitation and relief vs. lack of control, powerlessness, vagueness regarding responsibility, and resignation; (2) the relationship with unlicensed personnel - stimulation, possibility for mentoring, use of UP competence and the creation of fairness vs. questioning UP competence; and (3) The patients - increase in continuity, quicker treatment, and increased security vs. insecurity (with respect to, for example, the handling of medicine). Registered nurses perceptions of delegation within municipal healthcare involve their own work situation, the UP and the patients. Registered nurses who delegate to UP must be given time for mentoring such that the nursing care is safe care of high quality. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.
Ellner, Andrew L; Stout, Somava; Sullivan, Erin E; Griffiths, Elizabeth P; Mountjoy, Ashlin; Phillips, Russell S
Challenged by demands to reduce costs and improve service delivery, the U.S. health care system requires transformational change. Health systems innovation is defined broadly as novel ideas, products, services, and processes-including new ways to promote healthy behaviors and better integrate health services with public health and other social services-which achieve better health outcomes and/or patient experience at equal or lower cost. Academic health centers (AHCs) have an opportunity to focus their considerable influence and expertise on health systems innovation to create new approaches to service delivery and to nurture leaders of transformation. AHCs have traditionally used their promotions criteria to signal their values; creating a health systems innovator promotion track could be a critical step towards creating opportunities for innovators in academic medicine. In this Perspective, the authors review publicly available promotions materials at top-ranked medical schools and find that while criteria for advancement increasingly recognize systems innovation, there is a lack of specificity on metrics beyond the traditional yardstick of peer-reviewed publications. In addition to new promotions pathways and alternative evidence for the impact of scholarship, other approaches to fostering health systems innovation at AHCs include more robust funding for career development in health systems innovation, new curricula to enable trainees to develop skills in health systems innovation, and new ways for innovators to disseminate their work. AHCs that foster health systems innovation could meet a critical need to contribute both to the sustainability of our health care system and to AHCs' continued leadership role within it.
Oster, J; Melches, J
The members of the Bundesarbeitsgemeinschaft Künstlerische Therapien (BAG KT - "Working Committee of Art Therapies of the Federal Republic of Germany") decided to carry out an analysis of the occupational group of art therapists, in the form of an online inquiry. For this purpose, a questionnaire covering all fields of art therapies was developed, recording socio-demographic and qualification data, data of different fields of activity, patient characteristics, institutional conditions and setting as well as data on reimbursement. 2303 evaluable data sets are available. Here, the main focus is on art therapists in the health care sector according to SGB (N=2134). 83% of them are female, 56% work in the field of emergency medicine and curative treatment, followed by rehabilitation and youth welfare. In all sectors, specialization in music and art therapy predominates. 57% of the therapists have a special graduate degree in art therapy methods, 83% have a graduate degree. 42% have a license to work as an alternative non-medical practitioner. Nearly all of them use methods of quality management. The results highlight the implementation of art therapies in health care. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available The increasing use of natural rubber latex medical gloves in the last three decades has caused an increase in latex allergy. The majority of risk groups for allergy development include health care workers, workers in the rubber industry, atopic individuals and children with congenital malformations. Three types of pathological reactions can occur in people using latex medical gloves: irritant contact dermatitis, allergic contact dermatitis and immediate hypersensitivity. The latex allergy is caused by constituent components of latex gloves and added powders; there are also numerous latex allergens involved in cross-reactivity between latex and fruits and vegetables, the so-called latex-fruit syndrome. The diagnosis is based on an accurate history of exposure, clinical presentation and confirmatory in vivo and in vitro tests. Prevention is the easiest, most effective and least expensive way to avoid latex allergy. Powder-free latex gloves with reduced levels of proteins and chemicals, and synthetic gloves for allergic workers must be provided in the work environment. There are already many health care institutions around the world where all latex products have been replaced by synthetic material products.
We in health care are living and working in a world that, for all its technical changes, differs little in its basic assumptions, structures, payment systems, beliefs, expectations, and job titles from the world of health care a generation back. How much change can we expect over the coming years? A lot more than we are prepared for. Look at the array of new technologies headed our way, from genomic sciences to customized vaccinations. Many of the breakthroughs promise incredible abilities to prevent disease, to profile our proclivities, and to manage our genetic predispositions over long periods of time, rather than merely wait until the disease manifests in an acute phase, then treat the symptoms. Digital technologies bring physicians executives enormous opportunities for new ways of gathering, storing, and mining information, for new types of communication between medical professionals, for new communications with customers, and new ways of steering large, complex enterprises. Unprecedented opportunities for change keep piling in through the door. Vast pressures for change keep building from every side. And the rewards for anyone who can lead the change keep compounding.
The authors who contributed to this issue of Healthcare Papers have provided rich insights into a promising innovation agenda to support transformational change aimed at achieving high-performing, person-centric health systems that are sustainable and deliver value. First and foremost, the commentaries make clear that a focused innovation agenda with defined goals, objectives and milestones is needed, if innovation is to be a viable and successful strategy to achieve health system transformation. To date, innovation has been a catch-all term for solving the many challenges health systems are experiencing. Yet, innovation on its own cannot fix all the ills of a health system; strategic goals and objectives are needed to define the way forward if innovation is to achieve value for Canadians. To this end, the authors identify goals and objectives that are worthy of serious consideration by all health system stakeholders.
Ngunyulu, R N; Peu, M D; Mulaudzi, F M; Mataboge, M L S; Phiri, S S
Collaborative HIV care between the nurses and traditional health practitioners is an important strategy to improve health care of people living with HIV. To explore and describe the views of nurses regarding collaborative HIV care in primary healthcare services in the City of Tshwane, South Africa. A qualitative, descriptive design was used to explore and describe the views of nurses who met the study's inclusion criteria. In-depth individual interviews were conducted to collect data from purposively selected nurses. Content analysis was used to analyse data. Two main categories were developed during the data analysis stage. The views of nurses and health system challenges regarding collaborative HIV care. The study findings revealed that there was inadequate collaborative HIV care between the nurses and the traditional health practitioners. It is evident that there is inadequate policy implementation, monitoring and evaluation regarding collaboration in HIV care. The study findings might influence policymakers to consider the importance of collaborative HIV care, and improve the quality of care by strengthening the referral system and follow-up of people living with HIV and AIDS, as a result the health outcomes as implied in the Sustainable Development Goals 2030 might be improved. Training and involvement of traditional health practitioners in the nursing and health policy should be considered to enhance and build a trustworthy working relationship between the nurses and the traditional health practitioners in HIV care. © 2017 International Council of Nurses.
... U.S. Department of Health and Human Services Indian Health Service The Federal Health Program for American Indians and ... map can be used to find an Indian Health Service, Tribal or Urban Indian Health Program facility. This ...
Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in health care practices raise several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in health care practices as replacements of human care. I analyse them
Smith, Patrick O
Leadership is a crucial component to the success of academic health science centers (AHCs) within the shifting U.S. healthcare environment. Leadership talent acquisition and development within AHCs is immature and approaches to leadership and its evolution will be inevitable to refine operations to accomplish the critical missions of clinical service delivery, the medical education continuum, and innovations toward discovery. To reach higher organizational outcomes in AHCs requires a reflection on what leadership approaches are in place and how they can better support these missions. Transactional leadership approaches are traditionally used in AHCs and this commentary suggests that movement toward a transformational approach is a performance improvement opportunity for AHC leaders. This commentary describes the transactional and transformational approaches, how they complement each other, and how to access the transformational approach. Drawing on behavioral sciences, suggestions are made on how a transactional leader can change her cognitions to align with the four dimensions of the transformational leadership approach.
Background: The National Health Insurance Scheme (NHIS) was formally launched in Nigeria in 2005 as an option to help bridge the evident gaps in health care financing, with the expectation of it leading to significant improvement in the country's dismal health status indices. Primary Health Care (PHC) is the nation's ...
Murphy, John W
Primary health care has received a lot of attention since the Alma Ata Conference, convened by the World Health Organization in 1978. Key to the strategy to improve health care outlined at the Alma Ata conference is citizen participation in every phase of service delivery. Although the goals of primary health care have not been achieved, the addition of narrative medicine may facilitate these ends. But a new epistemology is necessary, one that is compatible with narrative medicine, so that local knowledge is elevated in importance and incorporated into the planning, implementation, and evaluation of health programs. In this way, relevant, sustainable, and affordable care can be provided. The aim of this article is to discuss how primary health care might be improved through the introduction of narrative medicine into planning primary health care delivery.
Niiranen, S; Lamminen, H; Mattila, H; Niemi, K; Kalli, S
Personal health care has obtained increasing importance in the field of health care as the populations' age in the industrialised countries and resources available for health care remain limited. Personal health care through digital television is an exiting possibility in the realisation of new types of services answering to this demand for increased personal action and responsibility in health care. The possibilities of digital television in health care are studied in the Health Care Television (HCTV) research project of the Digital Media Institute at Tampere University of Technology. In this paper personal health care services are studied mainly from the perspective of the interactive service infrastructure of digital television. Firstly we present the general infrastructure of digital television and the different interactive service types of digital television. The usage of these service types in personal health care applications is also discussed. Finally, a web-based application based on chronic atrial fibrillation and its test use is presented. The application is used as a research platform for personal health care applications in digital television.
Full Text Available The incentives of health care expenditure (HCE have been a topic of discussion in the USA (Obama reforms and in Europe (adjustment to debt crisis. There are competing views of institutional versus GDP (unit income elasticity and productivity related factors of growth of expenditure. However ageing of populations, technology change and economic incentives related to institutions are also key drivers of growth according to the OECD and EU’s AWG committee. Simulation models have been developed to forecast the growth of social expenditure (including HCEs to 2050. In this article we take a historical perspective to look at the institutional structures and their relationship to HCE growth. When controlling for age structure, price developments, doctor density and in-patient and public shares of expenditures, we find that fee-for-service in primary care, is according to the results, in at least 20 percent more costly than capitation or salary remuneration. Capitation and salary (or wage remuneration are at same cost levels in primary care. However we did not find the cost lowering effect for gatekeeping which could have been expected based on previous literature. Global budgeting 30 (partly DRG based percent less costly in specialized care than other reimbursement schemes like open contracting or volume based reimbursement. However the public integration of purchaser and provider cost seems to result to about 20 higher than public reimbursement or public contracting. Increasing the number of doctors or public financing share results in increased HCEs. Therefore expanding public reimbursement share of health services seems to lead to higher HCE. On the contrary, the in-patient share reduced expenditures. Compared to the previous literature, the finding on institutional dummies is in line with similar modeling papers. However the results for public expansion of services is a contrary one to previous works on the subject. The median lag length of
George, Susan; Leasure, A Renee
Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care.
Stöver, Heino; Wolff, Hans
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners. PMID:22390510
Pont, Jörg; Stöver, Heino; Wolff, Hans
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners.
insurance market, the elderly are at a serious disadvantage in obtaining coverage. Congress established the Medicare program to meet the health care ...not covered by Medicare, 1990a Acupuncture0 Chiropractic services Christian Science practitioners Cosmetic surgery0 Custodial care Dental care0...CRM 95-195 / November 1995 America’s Health: Recent Trends in Health Care Joyce S. McMahon • Michelle A. Dolfini-Reed • John A. Wilson 19960826
Petra Došenovič Bonča
Full Text Available The following paper analyses the possibilities of forming a single European health care market. This aim is achieved by studying the impact of the differing organisational features of individual European health care systems on the efficiency of health care provision, by examining the relationship between the inputs used to produce health care services and the population’s health status in the analysedcountries and by exploring the link between the quantity of health care services and the health status. The authors hypothesise that the efficiency and organisation of health care systems determine the possibilities of forming an efficient single European health care market. The empirical methodology employed in this paper isdata envelopment analysis (DEA. The results show that differences between health care systems and in the ownership types of health care providers are not so large as to prevent the formation of a single European health care market. However, the formation of a single European health care market would reveal the characteristicsof health care systems in such a way that citizens would be in favour of the public sector in health care and the national health service model.
Gawaine Powell Davies
Full Text Available Introduction: To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Description of policy: Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Discussion: Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.
Wiitala, Kris; Hwang, Ann
While health care organizations and public programs have recently demonstrated an increased interest in engaging patients and consumers as part of the implementation of new programs and policies, there is little published to date to guide these organizations in how to best engage consumers. We turn to an unconventional source-health care consumer advocates-who have developed experience in the type of consumer outreach, engagement, and activation that could help inform health care organizations and policy makers in further defining and studying engagement. We share perspectives from the field of advocacy that we believe could be applicable to health care organizations and policy makers working to build patient and family engagement, particularly in organizational governance and policy.
Bennis, Sandy; Costanzo, Diane; Flynn, Ann Marie; Reidy, Agatha; Tronni, Catherine
Simply implementing software and technology does not assure that an organization's targeted clinical and financial goals will be realized. No longer is it possible to roll out a new system--by solely providing end user training and overlaying it on top of already inefficient workflows and outdated roles--and know with certainty that targets will be met. At Virtua Health's Home Care, based in south New Jersey, implementation of their electronic system initially followed this more traditional approach. Unable to completely attain their earlier identified return on investment, they enlisted the help of a new role within their health system, that of the nurse informaticist. Knowledgeable in complex clinical processes and not bound by the technology at hand, the informaticist analyzed physical workflow, digital workflow, roles and physical layout. Leveraging specific tools such as change acceleration, workouts and LEAN, the informaticist was able to redesign workflow and support new levels of functionality. This article provides a view from the "finish line", recounting how this role worked with home care to assimilate information delivery into more efficient processes and align resources to support the new workflow, ultimately achieving real tangible returns.
Lundqvist, Pontus; Mathson, Anton
Elderly nowadays stay longer in their own home. This raises the standards on home care service to contribute to the maintenance of elderly’s general and oral health. Our objective is therefore to explore attitudes about how home care workers view oral health care and the importance of good oral health for elderly clients. 8 subjects (22 to 61 years of age) were selected for the study working in home care service, which all gave their informed consent. Semi-structured interviews were performed...
Integrated Health Care Barcelona Esquerra (Ais-Be: A Global View of Organisational Development, Re-Engineering of Processes and Improvement of the Information Systems. The Role of the Tertiary University Hospital in the Transformation
Full Text Available The Integrated Health Area “Barcelona Esquerra” ('Área Integral de Salud de Barcelona Esquerra' – AIS-BE, which covers a population of 524,000 residents in Barcelona city, is running a project to improve healthcare quality and efficiency based on co-ordination between the different suppliers in its area through the participation of their professionals. Endowed with an Organisational Model that seeks decision-taking that starts out from clinical knowledge and from Information Systems tools that facilitate this co-ordination (an interoperability platform and a website it presents important results in its structured programmes that have been implemented such as the Reorganisation of Emergency Care, Screening for Colorectal Cancer, the Onset of type 2 Diabetes Mellitus, Teledermatology and the Development of Cross-sectional Healthcare Policies for Care in Chronicity.
3 Austin, V. Medical Data Bases Patient Administration Systems and Biostatistics Activity (PAS&BA) (1986). In Proceedings, 198 AMEDD Forensic ...Health Care Administration, Baylor University, Waco , TX MEMBERSHIP: American Dietetic Association Phi Kappa Phi CERTIFICATION: Registered Dietitian...1986). Proceedings, 1985 AMEDD Forensic Psychology Symrosium, San Antonio, TX: U.S. Army Health Care Studies and Clinical Investigation Activity
Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A
Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.
Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.
Schaeffer, Leonard D
Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.
In his new book, futurist Russell C. Coile Jr. presents predictions about seven aspects of health care for the next five years. Aided by a panel of health care experts, he analyzes likely developments in health care consumerism, technology, managed care, and other areas that raise a number of issues for health care marketers. Even if only a few of these predictions come true, marketers will be forced to rethink some of their techniques to adapt to this rapidly changing environment.
Beasley, J.W.; Starfield, B.; Weel, C. van; Rosser, W.W.; Haq, C.L.
A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in
be greater.'4-'6. The broad view. Many factors contribute to one's health: quality and quantity of food, shelter, plumbing, living habits and genetics. What individuals do to themselves and what risks they take determine their relationships with health care professionals and are the foundation of the demand for health care.
Purpose: To evaluate the impact of educational intervention by health care providers on clinical outcomes in type 2 diabetes patients in a Yemeni health facility. Methods: A prospective, one-group and pre- and post-test design to assess the effects of health care providers' education on clinical patient outcomes was ...
Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes
Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in…
Y.G. Pillay; H. Subedar
This paper considers indications and obstacles for the development of primary mental health care practice in both developed and under-developed countries. Both are considered as this represents the South African reality. While a significant body of literature has documented the need for primary mental health care, the obstacles (especially in terms of the commodification of health) to its fruition are seldom addressed.
Greiner, Mary V; Beal, Sarah J
In 2012, the Comprehensive Health Evaluations for Cincinnati's Kids (CHECK) Center was launched at Cincinnati Children's Hospital Medical Center to provide health care for over 1,000 children placed into foster care each year in the Cincinnati community. This consultation model clinical program was developed because children in foster care have been difficult to manage in the traditional health care setting due to unmet health needs, missing medical records, cumbersome state mandates, and transient and impoverished social settings. This case study describes the history and creation of the CHECK Center, demonstrating the development of a successful foster care health delivery system that is inclusive of all community partners, tailored for the needs and resources of the community, and able to adapt and respond to new information and changing systems.
We show that when health care providers have market power and engage in Cournot competition, a competitive upstream health insurance market results in over-insurance and over-priced health care. Even though consumers and firms anticipate the price interactions between these two markets - the price set in one market affects the demand expressed in the other - Pareto improvements are possible. The results suggest a beneficial role for Government intervention, either in the insurance or the health care market.
Dookie, Sunitha; Singh, Shenuka
The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite South Africa's progress and attempts at implementing primary health care, various factors still limit its success. Inconsistencies and poor understanding of primary care and primary health care raises unrealistic expectations in service delivery and health outcomes, and blame is apportioned when expectations are not met. It is important for all health practitioners to consider the contextual influences on health and ill-health and to recognise the role of the underlying determinants of ill-health, namely, social, economic and environmental influences. The primary health care approach provides a strong framework for this delivery but it is not widely applied.There is a need for renewed political and policy commitments toward quality primary health care delivery, re-orientation of health care workers, integration of primary health care activities into other community-based development, improved management skills and effective coordination at all levels of the health system. There should also be optimal capacity building, and skills development in problem-solving, communication, networking and community participation. A well-functioning district health system is required for the re-engineering of primary health care. This strategy requires a strong leadership, a strengthening of the current district heath system and a greater emphasis on health promotion, prevention, and community participation and empowerment.
Full Text Available Abstract Background The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite South Africa’s progress and attempts at implementing primary health care, various factors still limit its success. Discussion Inconsistencies and poor understanding of primary care and primary health care raises unrealistic expectations in service delivery and health outcomes, and blame is apportioned when expectations are not met. It is important for all health practitioners to consider the contextual influences on health and ill-health and to recognise the role of the underlying determinants of ill-health, namely, social, economic and environmental influences. The primary health care approach provides a strong framework for this delivery but it is not widely applied. There is a need for renewed political and policy commitments toward quality primary health care delivery, re-orientation of health care workers, integration of primary health care activities into other community-based development, improved management skills and effective coordination at all levels of the health system. There should also be optimal capacity building, and skills development in problem-solving, communication, networking and community participation. Summary A well-functioning district health system is required for the re-engineering of primary health care. This strategy requires a strong leadership, a strengthening of the current district heath system and a greater emphasis on health promotion, prevention, and community participation and empowerment.
Background: Quality of care is a complex issue influenced by many factors. It is fundamental in assessing health care delivery in health facilities in developing countries. Health care workers' perceptions help policy makers and planners to identify bottlenecks in the system to improve utilisation and sustainability of health ...
Kolltveit, Beate-Christin Hope; Gjengedal, Eva; Graue, Marit; Iversen, Marjolein M; Thorne, Sally; Kirkevold, Marit
Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals' experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers. Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-based care, primary care and outpatient hospital clinics were recruited from the intervention arm of an ongoing cluster randomized controlled trial (RCT) (Clinicaltrials.gov: NCT01710774). Most were nurses (n = 29), but the sample also included one nurse assistant, podiatrists (n = 2) and physicians (n = 2). The participants reported experiencing meaningful changes to their practice arising from telemedicine, especially associated with increased wound assessment knowledge and skills and improved documentation quality. They also experienced more streamlined communication between primary health care and specialist health care. Despite obstacles associated with finding the documentation process time consuming, the participants' attitudes to telemedicine were overwhelmingly positive and their general enthusiasm for the innovation was high. Our findings indicate that using a telemedicine intervention enabled the participating health care professionals to approach their patients with diabetic foot ulcer with more knowledge, better wound assessment skills and heightened confidence. Furthermore, it streamlined the communication between health care levels and helped seeing the patients in a more holistic way.
The average health care expenditure in infancy was estimated to be 7.92 birr and it increased with increasing level of education and monthly family income. In all treatment ... increase the power of the family to spend some of their earnings for better care. Improving and .... Because of the skewed distribution of health care ...
Motwani, J; Sower, V E; Brashier, L W
This article examines the issue of implementing TQM/CQI programs in the health care industry by grouping the prescriptive literature into four research streams. Based on the literature, a strategic programming model for implementing TQM/CQI in the health care industry is suggested. Finally, issues relating to TQM in the health care sector, which need to be addressed within each research stream in the future, are provided.
De Lima, Liliana; Radbruch, Lukas
At the May 2014 meeting of the World Health Assembly, the assembly passed a resolution intended to reduce barriers to palliative care. T4eh resolution calls for integrating palliative care into national health services. It contains recommendation on improved availability and access to such care and calls for it to be included in national health policies and budgets. The full resolution with commentary is presented.
Maria de Fátima Siliansky de Andreazzi
Full Text Available Este texto procura extrair, da heterogeneidade apresentada pelo setor privado em saúde, no Brasil, o dado qualitativamente novo dos anos 90, bem como os desafios da nova dinâmica desse setor, especialmente em sua relação com o Estado. Apresenta uma introdução, apontando elementos considerados essenciais para a compreensão das mudanças ocorridas no setor saúde. Nessa perspectiva, localiza as mudanças no quadro de referência do modelo econômico adotado pelo país, nos anos 90, com foco nos desenvolvimentos vinculados aos ditames da globalização produtiva e, sobretudo, financeira. Em seguida, na segunda e terceira seções, são apresentadas as principais mudanças no interior do setor privado em saúde, quanto a demanda, oferta e suas inter-relações. Finalmente, à guisa de epílogo, são apresentados alguns dos desafios interpostos na relação entre os provedores e os consumidores de atenção à saúde, dita suplementar, ou a assistência à saúde "hors-SUS".This paper attempts to extract from the heterogeneity of the Brazilian private health care sector a qualitatively new characteristic of the 1990s, as well as the challenges of the sector's new dynamics, especially in its relationship to the public sector. The article's introduction discusses what are considered essential elements for understanding the changes occurring in the health sector. It situates the challenges within the framework of the economic model adopted in Brazil in the 1990s, focusing on developments linked to the dictates of productive (and especially financial globalization. The second and third sections present the principal changes in the private health care sector in relation to supply and demand and their interrelations. Finally, by way of epilogue, the article discusses some of the challenges arising in the relationship between suppliers and consumers of so-called supplementary health care, i.e., "à la National Health System".
Asarnow, Joan Rosenbaum; Hoagwood, Kimberly E.; Stancin, Terry; Lochman, John E.; Hughes, Jennifer L.; Miranda, Jeanne M.; Wysocki, Tim; Portwood, Sharon G.; Piacentini, John; Tynan, Douglas; Atkins, Marc; Kazak, Anne E.
Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health (a broad term referring to mental health, substance use, and health behavior) care in the United States. Advances in knowledge regarding effective treatment and services coupled with incentives for innovation in health and behavioral health care delivery systems make this a unique time for mobilizing our science to enhance the success of health and behavioral health care redesign. To optimize the potential of our current health care environment, a team was formed composed of leaders from the Societies of Clinical Child & Adolescent Psychology, Pediatric Psychology, and Child and Family Policy and Practice (Divisions 53, 54, and 37 of the American Psychological Association). This team was charged with reviewing the scientific and policy literature with a focus on five major issues: (a) improving access to care and reducing health disparities, (b) integrating behavioral health care within primary care, (c) preventive services, (d) enhancing quality and outcomes of care, and (e) training and workforce development. The products of that work are summarized here, including recommendations for future research, clinical, training, and policy directions. We conclude that the current emphasis on accountable care and evaluation of the outcomes of care offer numerous opportunities for psychologists to integrate science and practice for the benefit of our children, families, and nation. The dramatic changes that are occurring in psychological and behavioral health care services and payment systems also require evolution in our practice and training models. PMID:26430948
Asarnow, Joan Rosenbaum; Hoagwood, Kimberly E; Stancin, Terry; Lochman, John E; Hughes, Jennifer L; Miranda, Jeanne M; Wysocki, Tim; Portwood, Sharon G; Piacentini, John; Tynan, Douglas; Atkins, Marc; Kazak, Anne E
Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health (a broad term referring to mental health, substance use, and health behavior) care in the United States. Advances in knowledge regarding effective treatment and services coupled with incentives for innovation in health and behavioral health care delivery systems make this a unique time for mobilizing our science to enhance the success of health and behavioral health care redesign. To optimize the potential of our current health care environment, a team was formed composed of leaders from the Societies of Clinical Child & Adolescent Psychology, Pediatric Psychology, and Child and Family Policy and Practice (Divisions 53, 54, and 37 of the American Psychological Association). This team was charged with reviewing the scientific and policy literature with a focus on five major issues: (a) improving access to care and reducing health disparities, (b) integrating behavioral health care within primary care, (c) preventive services, (d) enhancing quality and outcomes of care, and (e) training and workforce development. The products of that work are summarized here, including recommendations for future research, clinical, training, and policy directions. We conclude that the current emphasis on accountable care and evaluation of the outcomes of care offer numerous opportunities for psychologists to integrate science and practice for the benefit of our children, families, and nation. The dramatic changes that are occurring in psychological and behavioral health care services and payment systems also require evolution in our practice and training models.
Wenger, A F
Decisions about health promotion and illness prevention occur within a cultural context that is influenced by the contemporary context of community and family in addition to the ethnohistorical and language contexts, worldview and sociocultural factors of the particular culture and the available folk and professional health care resources. Using information about the health and care beliefs and values and health care decision making process in negotiating culturally congruent nursing and health care interventions is imperative, especially in a world with limited health care resources and an increasing demand for recognition of cultural diversity. This article uses data on health and health care decision-making from an ethnonursing study of the Old Order Amish to demonstrate the role of cultural context in health care practices and decision making. Leininger's cultural care theory and Hall's conceptualization of high context culture were used to investigate these phenomena. High context features of the Old Order Amish culture are used to explain how Amish are actively involved in decisions and actions taken to promote health and prevent and treat illness using a broad array of folk, alternative and professional services simultaneously. As nurses learn to involve clients in decisions and actions using the guiding principles of cultural care preservation, accommodation and repatterning they will provide culturally congruent care for Amish and other culture-specific groups.
Derose, Kathryn Pitkin; Escarce, José J; Lurie, Nicole
Immigrants have been identified as a vulnerable population, but there is heterogeneity in the degree to which they are vulnerable to inadequate health care. Here we examine the factors that affect immigrants' vulnerability, including socioeconomic background; immigration status; limited English proficiency; federal, state, and local policies on access to publicly funded health care; residential location; and stigma and marginalization. We find that, overall, immigrants have lower rates of health insurance, use less health care, and receive lower quality of care than U.S.-born populations; however, there are differences among subgroups. We conclude with policy options for addressing immigrants' vulnerabilities.
... Series Urinary Tract Imaging Urodynamic Testing Virtual Colonoscopy Celiac Disease Testing (for Health Care Professionals) Serologic tests for celiac disease provide an effective first step in identifying candidates ...
Thorne, L M
Why are medical costs rising so rapidly? What are the factors involved that influence those costs? Does inflation affect health care costs? Can anything be done? The solutions to these complex issues are not clearly understood. It is clear, however, that the resolutions to these questions must be found quickly. If the causes of rising medical care costs are not promptly diagnosed and treated, we may find our economic health to be in critical condition. This paper attempts to better understand the reasons for increasing health care costs. The role that inflation plays relative to health care costs is investigated.
Pont, Jörg; Stöver, Heino; Wolff, Hans
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue...
Jun, Gyuchan Thomas; Ward, James; Morris, Zoe; Clarkson, John
The role of process modelling has been widely recognized for effective quality improvement. However, application in health care is somewhat limited since the health care community lacks knowledge about a broad range of methods and their applicability to health care. Therefore, the objectives of this paper are to present a summary description of a limited number of distinct modelling methods and evaluate how health care workers perceive them. Various process modelling methods from several different disciplines were reviewed and characterized. Case studies in three different health care scenarios were carried out to model those processes and evaluate how health care workers perceive the usability and utility of the process models. Eight distinct modelling methods were identified and characterized by what the modelling elements in each explicitly represents. Flowcharts, which had been most extensively used by the participants, were most favoured in terms of their usability and utility. However, some alternative methods, although having been used by a much smaller number of participants, were considered to be helpful, specifically in understanding certain aspects of complex processes, e.g. communication diagrams for understanding interactions, swim lane activity diagrams for roles and responsibilities and state transition diagrams for a patient-centred perspective. We believe that it is important to make the various process modelling methods more easily accessible to health care by providing clear guidelines or computer-based tool support for health care-specific process modelling. These supports can assist health care workers to apply initially unfamiliar, but eventually more effective modelling methods.
McHattie, Lynn-Sayers; Cumming, Grant; French, Tara
Until recently, the Western biomedical paradigm has been effective in delivering health care, however this model is not positioned to tackle complex societal challenges or solve the current problems facing health care and delivery. The future of medicine requires a shift to a patient-centric model and in so doing the Internet has a significant role to play. The disciplines of Health Web Science and Medicine 2.0 are pivotal to this approach. This viewpoint paper argues that these disciplines, together with the field of design, can tackle these challenges. Drawing together ideas from design practice and research, complexity theory, and participatory action research we depict design as an approach that is fundamentally social and linked to concepts of person-centered care. We discuss the role of design, specifically co-design, in understanding the social, psychological, and behavioral dimensions of illness and the implications for the design of future care towards transforming the patient experience. This paper builds on the presentations and subsequent interdisciplinary dialogue that developed from the panel session "Transforming Patient Experience: Health Web Science Meets Web 2.0" at the 2013 Medicine 2.0 conference in London.
Ashutosh Kumar Verma
Full Text Available Malaysia has a two-tier health care system consisting of the public and private sectors. The Ministry of Health is the main provider of health care services in the country. The private health care sector provides services on a nonsubsidized, fee-for-service basis, and mainly serves for those who can afford to pay. For financing health care two types of health insurances are available currently: Private and employee based (aka SOCSO. SOCSO and Employee Provident Fund provide some coverage to private-sector employees. There are several challenges in pure Bismarckian model (private insurance etc. like smaller portion of total population will be "economically active," international competition to attract firms, and maintain/increase employment will put downward pressure on labor taxes. How to sustain universal coverage in this context? In a population setting where unemployment is high informal sector, payroll taxes will not be a major source of funds. However, it is possible to create a universal health financing system by transforming the role of budget funding from directly subsidizing provision to subsidizing the purchase of services on behalf of the entire population. The integration of services between the public and private sector is very much needed, at a cost the people can afford. At present, there is no national health insurance scheme in place. Although there are many models proposed, the main question that the policymakers need to be aware of is that of the equity of access to holistic health services for all Malaysians.
Scammon, Debra L; Tomoaia-Cotisel, Andrada; Day, Rachel L; Day, Julie; Kim, Jaewhan; Waitzman, Norman J; Farrell, Timothy W; Magill, Michael K
To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived. An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design, its version of the Patient Centered Medical Home. Convergent case study mixed methods design. Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semistructured interviews, focus groups, Centers for Medicare and Medicaid Services database, and the Utah All Payer Claims Database. Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence. © Health Research and Educational Trust.
Jarvis, W R
In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term care for the elderly. The home-care industry and managed care have become major providers of health ca...
Johnston, Rosemary; DelConte, Beth A; Ungvary, Libby; Fiene, Richard; Aronson, Susan S
Many families enroll their infants and toddlers in early education and child care programs. The Pennsylvania Chapter of the American Academy of Pediatrics recruited 32 child care centers that care for infants and toddlers to be linked with a child care health consultant (CCHC). Project staff assigned the centers alternately to an immediate intervention or a 1-year delayed intervention (contrast) group. At entry into the project, and then 1 and 2 years later, an evaluator assessed center compliance with 13 standards for infants and toddler care selected from Caring for Our Children: National Health and Safety Performance Standards (3rd ed.). Project staff linked the Immediate Intervention centers with a CCHC in Year 1. In Year 2, in a crossover comparison, project staff linked Contrast centers with a CCHC. Working with a CCHC effectively improved compliance with some selected health and safety standards. Copyright © 2017 National Association of Pediatric Nurse Practitioners. All rights reserved.
Wang, Jian; Wu, Kuihua; Zhu, Wenbing; Gu, Chao
To improve the forecasting accuracy and ensure reliable and stable operation of transformer, based on health index estimation model is proposed. The transformer data is divided into different levels and parts, so multi-parameter statistical analysis is carried on. The indicator system is scored and weighted by computing history data (inspection and maintenance, family defects, basic information and loading history) and condition data (such as routine test data). The condition parameters, which are classified on the component level, are scored and weighted, using statistical tools calculation. By using the statistical tools SPSS (statistical product and service solutions), multivariate statistical analysis was carried out. On the basis of studying the relationship between various parameters, a health evaluation model, which is based on contribution analysis, is presented. A condition-based evaluation tool, that quantifies power transformer degradation and clarifies the relationship between each health index, is put forward. Results are presented to verify the validity and feasibility of evaluating model and assessment algorithm. This paper provides a scientific method for the transmitting and transforming field.
Teddie M Potter
Full Text Available Societal transformation often starts with one visionary and a compelling idea. However, if there are no followers, the idea quickly becomes marginalized. It “takes a village” to build a movement, and the more system layers that can be addressed, the more likely the transformation will take hold. This article describes the framework for creating the necessary changes for partnership-based health care. It also makes suggestions for ensuring successful application of partnership-based systems change. This article is for all readers seeking to apply partnership principles in their own fields of influence.
Liu, Y; Hsiao, W C; Eggleston, K
This paper examines the changes in equality of health and health care in China during its transition from a command economy to market economy. Data from three national surveys in 1985, 1986, and 1993 are combined with complementary studies and analysis of major underlying economic and health care factors to compare changes in health status of urban and rural Chinese during the period of economic transition. Empirical evidence suggests a widening gap in health status between urban and rural residents in the transitional period, correlated with increasing gaps in income and health care utilization. These trends are associated with changes in health care financing and organization, including dramatic reduction of insurance cover for the rural population and relaxed public health. The Chinese experience demonstrates that health development does not automatically follow economic growth. China moves toward the 21st century with increasing inequality plaguing the health component of its social safety net system.
Esma Kabasakal; Gülümser Kublay
Preventable diseases pose a serious problem worldwide. The role of primary healthcare professionals is especially significant in promoting health. Aim: It is aimed to determine the health care professionals working in family health centres have on health education and health promotion skills. Method: The study sample included 144 health care professionals employed in one of 33 family health centres in Ankara Province. The study data were collected using a survey developed on the h...
Curro, F A; Vena, D; Naftolin, F; Terracio, L; Thompson, V P
The NIDCR-supported Practice-based Research Network initiative presents dentistry with an unprecedented opportunity by providing a pathway for modifying and advancing the profession. It encourages practitioner participation in the transfer of science into practice for the improvement of patient care. PBRNs vary in infrastructure and design, and sustaining themselves in the long term may involve clinical trial validation by regulatory agencies. This paper discusses the PBRN concept in general and uses the New York University College of Dentistry's Practitioners Engaged in Applied Research and Learning (PEARL) Network as a model to improve patient outcomes. The PEARL Network is structured to ensure generalizability of results, data integrity, and to provide an infrastructure in which scientists can address clinical practitioner research interests. PEARL evaluates new technologies, conducts comparative effectiveness research, participates in multidisciplinary clinical studies, helps evaluate alternative models of healthcare, educates and trains future clinical faculty for academic positions, expands continuing education to include "benchmarking" as a form of continuous feedback to practitioners, adds value to dental schools' educational programs, and collaborates with the oral health care and pharmaceutical industries and medical PBRNs to advance the dental profession and further the integration of dental research and practice into contemporary healthcare (NCT00867997, NCT01268605).
nutrition, attendance of antenatal care, immunisation and discouraging behaviours such as excessive alcohol consumption.5,6,7 In addition this encourages the maximum utilization of the few available health workers thereby improving accessibility. Integrating mental health into primary health care –. Uganda's experience.
Alana Tamar Oliveira de Sousa; Solange Fátima Geraldo da Costa; Patrícia Serpa de Souza Batista; Jael Rúbia Figuêiredo de Sá França; João Paulo de Figuêiredo Sá
The Health Community Agent (HCA) has contributed in a meaningful way to enhance the bond professional-user/family, providing, thus, the humanized care for the users who receive attention from the Family Health Strategy (FHS...
Alana Tamar Oliveira de Sousa; Solange Fátima Geraldo da Costa; Patrícia Serpa de Souza Batista; Jael Rúbia Figuêiredo de Sá França; João Paulo de Figuêiredo Sá
The Health Community Agent (HCA) has contributed in a meaningful way to enhance the bond professional-user/family, providing, thus, the humanized care for the users who receive attention from the Family Health Strategy (FHS...
... Enter ZIP code here Health Awareness Campaigns: Sexual Trauma Sexual Trauma Women Veterans Health Care has created materials to ... 10-320LG Dimensions: 11" x 17" Effects of Sexual Trauma One in five women in the United States ...
... for the Obesity Epidemic KENNETH E. WARNER 99 8 Patterns and Causes of Disparities in Health DAVID R. WILLIAMS 115 9 Addressing Racial Inequality in Health Care SARA ROSENBAUM AND JOEL TEITELBAU...
Hutchison, Brian; Glazier, Richard
Primary care in Ontario, Canada, has undergone a series of reforms designed to improve access to care, patient and provider satisfaction, care quality, and health system efficiency and sustainability...
Rice, J A; Isakova, L; Zelckovich, R; Frid, E
Integrated health care systems: a concept being discussed throughout Russia and the world. A concept with three different applications and a confusing interaction with the concept of "capitation payments." The health reform debate in Russia and the NIS can only advance if greater clarity is found for these concepts, and if medical leaders are prepared for the substantial changes in provider behavior that are required with integrated health care systems fueled by capitation payments. This article explores the twin concepts of capitation and integrated health care systems, and then the leadership challenges for Russian health sector managers as they prepare for these challenges of the twenty-first century.
Alana Tamar Oliveira de Sousa; Solange Fátima Geraldo da Costa; Patrícia Serpa de Souza Batista; Jael Rúbia Figuêiredo de Sá França; João Paulo de Figuêiredo Sá
The Health Community Agent (HCA) has contributed in a meaningful way to enhance the bond professional-user/family, providing, thus, the humanized care for the users who receive attention from the Family Health Strategy (FHS). This research had the aim to investigate the strategies adopted by the health community agents in order to supply the humanized care for the FHS user. It is an exploratory research of qualitative nature which was accomplished in the Basic Health Units –...
Andrianarisoa, A O; Rampanjato, M
In 1976, Madagascar promised to establish 1500 primary health care centers to be run by a community health agent. The communities selected sites for the centers, nominated health agent candidates, built and maintained the centers and accommodation for the health agents, supplied the centers, and undertook their operation. The government organized the recruitment and training of the agents, paid their wages, and provided equipment and drugs. The candidates were 18-28 years old and had completed two years of secondary education. Training lasted 14 months and enabled the new agents to provide basic health care in the curative, preventive, and educational fields. The health agents can deal with normal births, family planning, vaccination, and health education. In 1991 the country had 1935 facilities that were providing primary care. Some 85% of the health agents have remained in the primary health care centers for over 10 years; 50 agents have moved out to become nurses or midwives. Financial support for the program comes from the state and external donors. Of the 1500 planned primary health care centers, 461 stopped functioning, mostly because the communities concerned have not adequately built and maintained premises for the health agents. The primary health care centers are less frequently attended than formerly because equipment is aging and drugs are in short supply. Cost recovery should be widely adopted in the national health system. More in-service training should be provided for health agents, and more tours of inspection should be carried out. Community health workers should be managed entirely by the community, and the Ministry of Health should take charge of their training. Primary health care in Madagascar has largely proved its worth; if the economic handicaps can be overcome, the program is likely to contribute to the achievement of the health-for-all goals.
Full Text Available In orders to promote the level of healthcare in societies, governments try to have different policies to transform the health system. The aim of this study was to measure the level of awareness of practitioners in Iran, after initiating the new transformation of the health system in the country, starting from May 2014. This is a descriptive–cross-sectional study, which was inducted in October 2014. The study population consists of 208 physicians who attended the 26th International Congress of Pediatrics in Tehran, Iran. Data was collected using a self-structured questionnaire, which was estimated as both reliable and valid. Two hundred and eight questionnaires were returned. The results showed that 79.1% of the practitioners were aware of the new health system. Indeed 48.3% of the participants believed that the system was successful. 57.7% of physicians were completely aware of the time of the new system settlement in the country, while the rest had either no idea or did not know the exact date. The participants suggested a few items promote the health system in the country; among them, decreasing the direct payment between patients and physicians was suggested most frequently. According to the results obtained from the study, it is suggested that health care administrators have a detailed plan for health care workers prior to settlement of a new health policy installment, in order to succeed in settlement of a program.
Tung, Elizabeth L; Gao, Yue; Peek, Monica E; Nocon, Robert S; Gunter, Kathryn E; Lee, Sang Mee; Chin, Marshall H
To examine the relationship between medical home transformation and patient experience of chronic illness care. Thirteen safety net clinics located in five states enrolled in the Safety Net Medical Home Initiative. Repeated cross-sectional surveys of randomly selected adult patients were completed at baseline (n = 303) and postintervention (n = 271). Questions from the Patient Assessment of Chronic Illness Care (PACIC) (100-point scale) were used to capture patient experience of chronic illness care. Generalized estimating equation methods were used to (i) estimate how differential improvement in patient-centered medical home (PCMH) capability affected differences in modified PACIC scores between baseline and postintervention, and (ii) to examine cross-sectional associations between PCMH capability and modified PACIC scores for patients at completion of the intervention. In adjusted analyses, high PCMH improvement (above median) was only marginally associated with a larger increase in total modified PACIC score (adjusted β = 7.7, 95 percent confidence interval [CI]: -1.1 to 16.5). At completion of the intervention, a 10-point higher PCMH capability score was associated with an 8.9-point higher total modified PACIC score (95 percent CI: 3.1-14.7) and higher scores in four of five subdomains (patient activation, delivery system design, contextual care, and follow-up/coordination). We report that sustained, 5-year medical home transformation may be associated with modest improvement in patient experience of chronic illness care for vulnerable populations in safety net clinics. © Health Research and Educational Trust.
Kees JM van Haaster
Transforming youth care through online simulation gaming. Aligning the positions of practitioners and observersThe youth care service in the Netherlands is currently undergoing a major transition from national and regional finance and control to localized regulation and responsibility. The aim is to initiate a transformation towards greater intervention value and to support greater self-reliance in social networks. Effective youth care depends largely on the quality of the network exchange. I...
Dulal, R K
Nepal has entered from its unitary system into a new "Federal Democratic Republic State". The current constitution presents basic health care services as a fundamental right. The Ministry for Health and Population has been providing resources to meet health demands, but managers are wrestling to meet these demands. Persistent disparities between rural and urban and across regions resulted inferior health outcomes, e.g., life expectancy in an urban district like Bhaktapur is 71 years, whereas in the rural district of Mugu it is 44 years. The poor health and poor access to health care in the past systems prompted people to seek a different model. Ultimately, all political parties except one have agreed on federalism. The exact number of federal states that are going to be created is unknown. In federalism, all federated states have to assume certain relationships between the locality, the region, and the nation that apply not only in politics but in health care too. Managing changes in health care organization during the transitional period and after restructuring the unitary Nepal into federal states should be carefully planned. In case, if new system also fails to deliver necessary health care services, the possibility of igniting of dissatisfaction, public unrest and even disintegration cannot be ignored. In order to outline a structure and give life to a health care system under federalism, health care professionals need to engage themselves seriously.
K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)
textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a
Sklar, David P; Hemmer, Paul A; Durning, Steven J
The transformation of the U.S. health care system is under way, driven by the needs of an aging population, rising health care spending, and the availability of health information. However, the speed and effectiveness of the transformation of health care delivery will depend, in large part, upon engagement of the health professions community and changes in clinicians' practice behaviors. Current efforts to influence practice behaviors emphasize changes in the health payment system with incentives to move from fee-for-service to alternative payment models.The authors describe the potential of medical education to augment payment incentives to make changes in clinical practice and the importance of aligning the purpose and goals of medical education with those of the health care delivery system. The authors discuss how curricular and assessment changes and faculty development can align medical education with the transformative trends in the health care delivery system. They also explain how the theory of situated cognition offers a shared conceptual framework that could help address the misalignment of education and clinical care. They provide examples of how quality improvement, health care innovation, population care management, and payment alignment could create bridges for joining health care delivery and medical education to meet the health care reform goals of a high-performing health care delivery system while controlling health care spending. Finally, the authors illustrate how current payment incentives such as bundled payments, value-based purchasing, and population-based payments can work synergistically with medical education to provide high-value care.Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a "work of the United States Government" for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the
Millward, Lynne J; Bryan, Karen
This paper aims to briefly review leadership within the contemporary UK National Health Services (NHS) including Department of Health and Royal College of Nursing (RCN) initiatives. It is argued that the concept of clinical leadership is a viable and important one, and is theoretically consistent with the contemporary social psychological literature on the importance of "local" leadership to effective organizational functioning. Field theory proposes that local influences (e.g. local management) on attitudes and behaviour will to a large extent mediate the impact of the organization (e.g. organisational structure and values) on (in this instance) health care delivery. The reality of clinical leadership must involve a judicious blend effective management in the conventional sense with skill in transformational change in order to make real difference to the care delivery process. For leadership initiatives to become truly culturally embedded into the "way we do things around here", they require more than just individual training and development. A view is offered for the practical interpretation of the clinical leadership concept in relationship terms. This will involve management of the relationship between health care professionals, between health care professionals and the "organizations" to which they are accountable and between health care professionals and service users.
This reduction was not achieved through the use of sophisticated care such as bone marrow transplant, but through the adoption of a Comprehensive Health Care Management protocol for sickle cell disease. This protocol of care emphasizes prevention of crises through effective management of the disease. In Africa, where ...
Cordera, A; Bobenrieth, M
This paper describes the basic educational planning process involved in primary health care programs in developing countries. The problem in present educational programs are the lack of concentration by educators on the distribution of resources and the lack of achieving objectives of specific services. Educational planning seeks to ascertain the existing situation in a defined social setting in order to develop educational programs consistent with general development efforts. General learning and motivation principles include meaningfulness, requirements, modeling, open communication, freshness, active practice, adequate distribution of practical work, phasing out assistance, and developing agreeable conditions for learning. The purpose of an educational program should be "product-oriented" or "impact-oriented." Educational objectives can be reached through a process of elements in a cognitive, affective, or psycomotor domain. The curriculum process includes the following 5 stages: 1) selection of purpose and objectives, 2) organization of learning experiences, 3) selection of program content material), 4) selection of teaching methods, and 5) evaluation of the effectiveness of stages 2-4.
Payne, Julianne; Razi, Sima; Emery, Kyle; Quattrone, Westleigh; Tardif-Douglin, Miriam
Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.
Brink-Muinen, A. van den; Bensing, J.M.; Kerssens, J.J.
Objectives: differences were investigated between general practitioners providing women's health care (4 women) and general practitioners providing regular health care (8 women and 8 men). Expectations were formulated on the basis of the principles of women's health care and literature about gender
Flanagan, Elaine; Chopra, Teena; Mody, Lona
With the changing health care delivery, patients receive care at various settings, including acute care hospitals, skilled nursing facilities (SNFs), and ambulatory clinics, thus becoming exposed to pathogens. Various health care settings face unique challenges requiring individualized infection control programs. The programs in SNFs should address surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs. In ambulatory clinics, the program should address triage and standard transmission-based precautions; cleaning, disinfection, and sterilization principles; surveillance in surgical clinics; safe injection practices; and bioterrorism and disaster planning. Published by Elsevier Inc.
Andersen, Kim Normann; Agger Nielsen, Jeppe; Kim, Soonhee
This paper brings forward five propositions on the use of online communication in health care, its potential impacts on efficiency and effectiveness in health care, and which role government should play in moving forward the use of online communication. In the paper, each of the five propositions...
Josyula, Lakshmi; Lyle, Roseann
Purpose: To examine the feasibility and impact of a health care provider’s (HCP) physical activity (PA) prescription on the PA of patients on preventive care visits. Methods: Consenting adult patients completed health and PA questionnaires and were sequentially assigned to intervention groups. HCPs prescribed PA using a written prescription only…
The Social Protection Model in Latin America. 3. After a Decade of Reforms in Latin America. 7. Some Issues in Comparative Analysis. 12. Methodological Options. 20. Section II. Analysis of Health Care Policies. Chapter 2. The Context and Process of Health Care. Reform in Argentina — Susana Belmartino. 27. Introduction.
Westert, G.P.; Berg, M.J. van den; Koolman, X.; Verkleij, H.
This is the second national report on the performance of the Dutch health care system. Its focus is on quality, access and costs in 2006/7. The Dutch Health Care Performance Report presents a broad picture based on 110 indicators. Where possible, comparisons in time and between countries are
Conclusions: This study has served to investigate the general skills of health care professionals in regard to patient safety. It provides new knowledge about the topic in the context of the Baltic countries and can thus be used in the future development of health care services.
Klecun, Ela; Lichtner, Valentina; Cornford, Tony
This paper explores notions of e-Literacy (otherwise IT literacy or digital literacy) in health care. It proposes a multi-dimensional definition of e-Literacy in health care and provides suggestions for policy makers and managers as to how e-Literacy might be accounted for in their decisions.
E.K.A. van Doorslaer (Eddy); O.A. O'Donnell (Owen); R.P. Rannan-Eliya (Ravi); A. Somanathan (Aparnaa); S.R. Adhikari (Shiva Raj); C.C. Garg (Charu); D. Harbianto (Deni); A.N. Herrin (Alejandro); M.N. Huq (Mohammed); S. Ibragimova (Shamsia); A. Karan (Anup); T-J. Lee (Tae-Jin); G.M. Leung (Gabriel); J-F.R. Lu (Jui-fen Rachel); C.W. Ng (Ng); B.R. Pande (Badri Raj); R. Racelis (Rachel); S. Tao (Tao); K. Tin (Keith); K. Tisayaticom (Kanjana); L. Trisnantoro (Laksono); C. Vasavid (Vasavid); Y. Zhao (Yuxin)
textabstractOut-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that
Roemeling, Oskar; Land, Martin; Ahaus, C
Purpose - The purpose of this paper is to investigate the roles that employee-initiated Lean improvement projects play in health care. Lean ideas are introduced to improve flow in health care. Although variability is detrimental to flow performance, it is unclear whether Lean initiatives set out to
Leininger, Lindsey; Levy, Helen
It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health.…
Bogdanova, Ruta; Šilina, Maruta; Renigere, Ruta
In the 21st century, numerous complex challenges in education and health care have come to the fore, among them: 1) how to implement the ecological approach in the education process and health care practice; 2) how to implement study programmes in line with the education trends for "sustainable development" and the process of formation…
Van Bewer, Vanessa
To analyze the concept of transdisciplinarity and provide an enhanced definition of transdisciplinarity in health care. The term transdisciplinarity is increasingly prevalent in health care research and has been identified as important to improving the effectiveness and efficiency in health care. However, the term continues to be misappropriated and poorly understood by researchers and clinicians alike which hinders its potential use and impact. Walker and Avant's (2005) method of concept analysis was used as a framework for the study of the concept. The databases PubMed, CINAHL, Academic Search Premier, PsycInfo and ERIC were used searching the terms transdisciplinarity, transdisciplinary, interdisciplinary and interdisciplinarity. Transdisciplinarity in health care involves transcending of disciplinary boundaries, a sharing of knowledge, skills and decision-making, a focus on real-world problems and the inclusion of multiple stakeholders including patients, their families and their communities. An enhanced definition of transdisciplinarity in health care emerged from this concept analysis that may provide clarity and direction for health care providers. Nurses, and other health care providers, can look to this definition to understand transdisciplinary health care teams as opposed to multidisciplinary, and interdisciplinary ones. © 2017 Wiley Periodicals, Inc.
Mate, Kedar S; Salinas, Gilbert
There is considerable interest in ideas borrowed from education about "flipping the classroom" and how they might be applied to "flipping" aspects of health care to reach the Triple Aim of improved health outcomes, improved experience of care, and reduced costs. There are few real-life case studies of "flipping health care" in practice at the individual patient level. This article describes the experience of one of the authors as he experienced having to "flip" his primary health care. We describe seven inverted practices in his care, report outcomes of this experiment, describe the enabling factors, and derive lessons for patient-centered primary care redesign. Copyright © 2014 Elsevier Inc. All rights reserved.
Karuppan, Corinne M; Karuppan, Muthu
Despite much coverage in the popular press, only anecdotal evidence is available on medical tourists. At first sight, they seemed confined to small and narrowly defined consumer segments: individuals seeking bargains in cosmetic surgery or uninsured and financially distressed individuals in desperate need of medical care. The study reported in this article is the first empirical investigation of the medical tourism consumer market. It provides the demographic profile, motivations, and value perceptions of health care consumers who traveled abroad specifically to receive medical care. The findings suggest a much broader market of educated and savvy health care consumers than previously thought. In the backdrop of the health care reform, the article concludes with implications for health care providers.
In light of the ongoing debate about health care policy in the United States, including efforts to repeal and replace the Affordable Care Act, it will be critically important for the academic community to engage in the dialogue. Developing a viable approach to health care reform requires an understanding of the interaction and interdependence between choice, cost, and coverage in a competitive and functional market-based system. Some institutions have implemented models that indicate the feasibility of providing high-quality, efficient patient care while working within fixed budgets. The academic community must stay engaged in these conversations because of its moral commitment to equitable access to health care for all. Academic medical centers will also have to define and protect their roles in an evolving health care delivery system in the United States.
Simpser, Edwin; Hudak, Mark L
Pediatric home health care is an effective and holistic venue of treatment of children with medical complexity or developmental disabilities who otherwise may experience frequent and/or prolonged hospitalizations or who may enter chronic institutional care. Demand for pediatric home health care is increasing while the provider base is eroding, primarily because of inadequate payment or restrictions on benefits. As a result, home care responsibilities assumed by family caregivers have increased and imposed financial, physical, and psychological burdens on the family. The Patient Protection and Affordable Care Act set forth 10 mandated essential health benefits. Home care should be considered as an integral component of the habilitative and rehabilitative services and devices benefit, even though it is not explicitly recognized as a specific category of service. Pediatric-specific home health care services should be defined clearly as components of pediatric services, the 10th essential benefit, and recognized by all payers. Payments for home health care services should be sufficient to maintain an adequate provider work force with the pediatric-specific expertise and skills to care for children with medical complexity or developmental disability. Furthermore, coordination of care among various providers and the necessary direct patient care from which these care coordination plans are developed should be required and enabled by adequate payment. The American Academy of Pediatrics advocates for high-quality care by calling for development of pediatric-specific home health regulations and the licensure and certification of pediatric home health providers. Copyright © 2017 by the American Academy of Pediatrics.
Pushpangadan, M.; Burns, E.
Many frail or disabled elderly people are now being maintained in the community, partially at least as a consequence of the Community Care Act 1993. This paper details the work of the major health professionals who are involved in caring for older people in the community and describes how to access nursing, palliative care, continence, mental health, Hospital at Home, physiotherapy, occupational therapy, equipment, and optical, dental, and dietetic services. In many areas, services are evolvi...
Hilton Giovani Neves
Full Text Available This study was based on descriptive, exploratory and qualitative approach and aimed at analyzing scientific knowledge that was developed in the formation of Family Health (FH nurses to address Mental Health in Primary Care regarding psychosocial aspects. Research conducted in 2008 with three teams of FH nurses a municipality in the countryside of Mato Grosso, whose data were submitted to content analysis. The results were organized according to two themes "The limitations of official spaces for the training of nurses" and "The Family Health as well as the transformation praxis in Mental Health ". It was concluded that the official spaces mentioned above do not give too much importance to education on mental health, the same occurs in the context of lifelong learning. Despite the limited provision of skills for Mental Health care, we have found significant changes such as the sensitization to emotional and psychological manifestations of the population with higher awareness of health.
Bisantz, Ann M; Fairbanks, Rollin J
Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...
Wang, H A; Wang, Y Z; Wang, S
The personal computer and the Internet have provided many useful services to both health care professionals and the general public. However, security remains a key factor that could limit their further growth potential. We reviewed and assessed the potential use of the cryptographic technique to resolve security issues. We also analyzed services available in the current market environment and determined their viability in supporting health care applications. While the cryptographic application has a great potential in protecting security of health care information transmitted over the Internet, a nationwide security infrastructure is needed to support deployment of the technology. Although desirable, it could be cost prohibitive to build a national system to be dedicated for the health care purpose. A hybrid approach that involves the government's development of a dedicated security infrastructure for health care providers and the use of commercial off-the-shelf products and services by the general public offers the most cost-effective and viable approach.
... Orthopedic Health Joint Health and Care: Prevention, Symptoms, Diagnosis & Treatment Past Issues / Spring 2009 Table of Contents For ... may be used to help achieve an accurate diagnosis, including: ... joint for examination Treatment The only type of arthritis that can be ...
Andrade, Raquel Dully; Mello, Débora Falleiros; Silva, Marta Angélica Iossi; Ventura, Carla Aparecida Arena
This narrative literature review aimed to identify the publications about health law, in the ambit of child health care. The databases LILACS and MEDLINE were searched, between 2004 and 2009. Thirteen articles were analyzed, and three themes were identified: Emphasis on knowledge, abilities and attitudes for the development of competencies; Partnerships as an imperative; Health and Law: intersectorial relationship. The studies about the practice of health law are relevant to our reality, especially in primary health care, pointing out for the possibilities of its applicability in the role of the nurses acting in the family health strategy, with families and children.
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.
Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L
Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. © The Author(s) 2014.
Tapia-Conyer, Roberto; Gallardo-Rincón, Héctor; Saucedo-Martínez, Rodrigo
The increasing prevalence of non-communicable diseases (NCDs) has impacted the health systems by demanding unbearable costs of care and diminishing people's quality of life. The Instituto Carlos Slim de la Salud, a non-profit organization, has developed the model Casalud to convene partnerships with state governments to establish a reengineering process of primary care clinics, improving the delivery of services and leveraging on the different technological platforms to connect them with the households. The model Casalud strengthens the delivery of services and increases the timely demand of care. It is actually implemented in seven states seeking a progressive scale-up.
Sun, Yuelian; Gregersen, Hans; Yuan, Wei
China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources. PMID:28356772
Nadeau, Lucie; Jaimes, Annie; Rousseau, Cécile; Papazian-Zohrabian, Garine; Germain, Kateri; Broadhurst, Joanna; Battaglini, Alex; Measham, Toby
The Quebec Plan d'action en santé mentale (PASM) (Mental Health Action Plan) reform, a major transformation of the province's mental health care system, has put primary care rather than hospital-based care at the forefront of mental health service delivery. This study documents perceptions of changes in child and youth mental health (CYMH) services following the reform, as well as facilitators and obstacles to collaboration and partnership in CYMH services, and the specific challenges related to collaboration and partnership when servicing multi-ethnic populations. This qualitative participatory research study collected data using semi-structured individual interviews, focus groups and participant observation in community-based health and social service institutions. Thematic analysis was performed. The reform process encountered challenges in building a common culture of care within and between institutions, while collaboration and partnership evolved in a positive direction throughout the study. Study results highlighted the importance of fostering communication at all levels. Collaboration and partnership was facilitated by opportunities for clinical discussions, dialogue on models of care, harmonizing administrative and clinical priorities, and involving key actors and structures. The results revealed difficulties in implementing multidisciplinary work and in negotiating partners' responsibilities. Quality of partnership and collaboration appeared particularly crucial in providing optimal care to vulnerable families, including migrants. The PASM reform involved a major and challenging transformation in CYMH services. Continuous dialogue through time and leadership sharing appeared promising to foster this transformation.
This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
van Offenbeek, M.A.G.; Kiewiet, D.J.; Oosterhuis, M.
Background: In the Netherlands the medical education system is in the process of being transformed to establish a more demand-oriented health care system. This transformation may entail the occupational restructuring of the medical profession. Meanwhile, on the supply side, the career intentions of
Macinko, James; Montenegro, Hernán; Nebot Adell, Carme; Etienne, Carissa
At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.
An important aspect of allowing patients to take control of their health care is the introduction of new procedures for dealing with complaints. This article examines the concepts that underpin the new Department of Health regulations on complaints management and what they will mean for health and social care professionals. It also explains why these regulations focus on restorative justice rather than blame when adverse events occur.
Full Text Available This paper considers indications and obstacles for the development of primary mental health care practice in both developed and under-developed countries. Both are considered as this represents the South African reality. While a significant body of literature has documented the need for primary mental health care, the obstacles (especially in terms of the commodification of health to its fruition are seldom addressed.
López-Cevallos, Daniel; Chi, Chunhuei; Ortega, Fernando
The present study was aimed at analysing socioeconomic inequity regarding the use of health services in Ecuador, inequity regarding the geographic distribution of healthcare-related human resources and reflecting on the challenges concerning equity which the Ecuadorian health system is currently facing. The Ecuadorian Demographic, Maternal and Infant Health Survey (2004) was used as the main data source, as its sample was representative of the Ecuadorian population. Multilevel multivariate analysis (MLWiN 2.02 statistical software) and spatial data analysis regarding health resources (GeoDa 1.0.1) were used for estimating the effects of using health services. It was found that social, economic and geographic inequity limited access to health services in Ecuador. People living in low economic resource households or indigenous housing and people living in rural areas (many of them having all three characteristics at the same time) had less possibility of using health services. In spite of a marked concentration of health-service providers in urban areas, it was found that the presence of healthcare personnel (excluding doctors) in rural public entities increased the possibility of using preventative and curative services. Efforts at transforming the Ecuadorian health system must be aimed at reducing social, cultural and financial barriers and inequality regarding the distribution de healthcare-related human resources, particularly in rural areas. Community and family orientation of the services and increasing spaces for citizen participation are necessary for reducing such inequity.
Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forego needed care or to report difficulty finding a provider, even after controlling for other factors including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after controlling for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way. PMID:27043757
Health insurance, in addition to being a technique for controlling and managing health risks, helps in placing the insured in a position for accessing health care delivery ahead of an illness. This instrument, which has been well utilized in developed economies, is what the National Health Insurance Scheme (NHIS) in Nigeria ...
Hudson, Christopher G.; DeVito, Jo Anne
Reviews research pertinent to mental health services under health care reform proposals. Examines redistributional impact of inclusion of outpatient mental health benefits, optimal benefit packages, and findings that mental health services lower medical utilization costs. Argues that extending minimalist model of time-limited benefits to national…
The impacts of disasters are numerous and devastating on both the health of the human populations and the vital infrastructure. Public health therefore views disasters ... disasters on public health and the health care system within the fundamental principles that guide the ..... An uncontrolled fire occurring in vegetation more.
Prætorius, Thim; Becker, Markus
Understanding how health care organizations can achieve care coordination internally is essential because it is difficult to achieve, but essential for high quality and efficient health care delivery. This article offers an answer by providing a synthesis of knowledge about coordination from...... organization theory, where coordination is a central research topic. The article focuses on intra-organizational coordination, which is challenging especially across boundaries such as departments or professions. It provides an overview of the classic coordination mechanisms, e.g., standardization of work...
... care + Share widget - Select to show What’s home health care? What's home health care? Home health care is a wide range of ... listed. What should I expect from my home health care? Doctor’s orders are needed to start care. Once ...
Hess, Jeremy; Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica
Petroleum is used widely in health care-primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies-and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services.
Full Text Available The process of collective education in an organization that has the capacity to impact an organization’s operations, performance and outcomes is called organizational learning. In health care organizations, patient care is provided through one or more visible and invisible teams. These teams are composed of experts and novices from diverse backgrounds working together to provide coordinated care. The number of teams involved in providing care and the possibility of breakdowns in communication and coordinated care increases in direct proportion to sophisticated technology and treatment strategies of complex disease processes. Safe patient care is facilitated by individual professional learning; inter-professional team learning and system based organizational learning, which encompass modified context specific learning by multiple teams and team members in a health care organization. Organizational learning in health care systems is central to managing the learning requirements in complex interconnected dynamic systems where all have to know common background knowledge along with shared meta-knowledge of roles and responsibilities to execute their assigned functions, communicate and transfer the flow of pertinent information and collectively provide safe patient care. Organizational learning in health care is not a onetime intervention, but a continuing organizational phenomenon that occurs through formal and informal learning which has reciprocal association with organizational change. As such, organizational changes elicit organizational learning and organizational learning implements new knowledge and practices to create organizational changes.
also for disabled and disorientated users. Additional requirements to facilitate recovery and the breakdown of stigma as mentioned during personal interviews by health care professionals at HJH include: - mental health care facilities should be designed to have a home-like rather than institutional atmosphere; - spaces.
Introduction. Reliable data is necessary to facilitate the effective planning, management and restructuring of mental health care facilities. Access to accurate information on clinical conditions, treatment outcomes and expenditure is essential to ensure accountability, quality and cost-effective mental health care. This article is ...
first of three that reports on a review of a local acute mental health care unit in a general ... Method: The study reviewed the existing mental health care program and activities in context of relevant policy and legislation. Results: Norms from a ... current physical facilities and structure of the unit and of the utilization of available ...
Objective: This is the third of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). The study reviewed existing South African standards for mental health care facilities. Architectural principles and implications for the use of space were deducted from recent legislation. Objectives were to ...
Objective: This is the first of three reports on a follow-up review of mental health care at Helen Joseph Hospital (HJH). In this first part, qualitative and quantitative descriptions were made of the services and of demographic and clinical data on acute mental health care users managed at HJH, in a retrospective review of ...
Sandager, Mette; Sperling, Cecilie; Jensen, Henry
and better involvement of patient and relatives. The study indicates that women, younger and higher educated patients tend to be less satisfied with the health care they received. This study shows that even though the majority of patients are satisfied with the quality of health care, there is room......Patient’s experiences and patient surveys are increasingly being used for the evaluation of the quality of health care. Patient information is valuable input when we aim to improve healthcare services. The aim of this study was to assess Danish cancer patients’ experiences and assessment...... of the health care they have received, in regard to access to diagnostics, coordination and continuity of care, information and communication and involvement of patients and relatives. Questions and the opportunity to comment in free text were distributed to 6,720 newly diagnosed cancer patients in the summer...
Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L; Hedges, Dawson W
(1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass. Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass. Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows. Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior. © 2014 National Rural Health Association.
Pillay, Y G
There have, of late, been repeated calls for the transformation of the South African health care system. While there are political and economic consequences involved, there are also bio-ethical sequelae. This paper attempts to explore some of the bio-ethical dilemmas that confront both the 'consumers' and the architects of a new health policy (including the State; professional health groupings, e.g. the Medical Association of South Africa; and the so-called progressive health organisations, e.g. the National Medical and Dental Association and the South African Health Workers' Congress). While the literature has focused on libertarian and utilitarian ethical theories, communitarian perspectives are not often mentioned. This paper attempts to redress this perceived deficit.
The question of corporate moral responsibility--of whether it makes sense to hold an organisation corporately morally responsible for its actions, rather than holding responsible the individuals who contributed to that action--has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom (UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the health care context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially amoral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish.
Tor I. Romøren
Full Text Available Introduction: The Norwegian health care system is well organized within its two main sectors - primary health and long term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures. Policy practice: Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term "Coordination Reform". These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented. Discussion: The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden.
Tor I. Romøren
Full Text Available Introduction: The Norwegian health care system is well organized within its two main sectors - primary health and long term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures.Policy practice: Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term "Coordination Reform". These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented.Discussion: The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden.
Le Var, R M
There is increasing evidence that the health care needs of people from black and ethnic minority groups in England are not being met. A growing number of initiatives are being undertaken to remedy the situation. Many of them are focused on health care delivery at local and national levels. However, unless the preparation of health care professionals in the area of multi-cultural health care is appropriate and effective, a great deal of corrective action will continue to have to be taken. Despite 1997 having been the European Year Against Racism, it is still necessary to consider what educational preparation should be like. The article draws on identified inadequacies in health care provision as well as examples of initiatives taken to improve care provision. The author identifies deficiencies in educational preparation and proposes a range of actions to be taken. The article is focused on nursing, midwifery and health visiting education in England, but is deemed to be relevant to all health care professionals not only in Europe but other continents, as they become increasingly international and multi-ethnic.
Full Text Available RQ: Personal excellence of nursing focusing on self-transcendence and achievements is crucial for achieving excellence in health care. The question is whether there is unequal treatment of patients despite high ethical standards placed in health care.Purpose: Professional nurses code is a guide in assessing their ethical performance. People are different amongst each other, but have the same rights in the health system, which should be provided by health care services. The need to overcome inequalities has become a cornerstone of excellence in health care.Method: A small quantitative survey of nurses was conducted in one of the departments in a Slovenian hospital. To analyse the results, we used frequency statistics, Spearman's rank correlation test and chi-square test. Results: Providers of health care services are aware of the importance of ethics in its formation. Professional Code is relatively well known; 8.4 % of the respondents were not sure if they clearly define the principles of respect for equality. Discrimination, caused by providers of health care, is of a less extent. Ethical awareness among health care providers does not affect identification with the profession. The education level ofnursing personnel and the perception of discrimination based on religious affiliation influenced one another. Education has no influence on the perception of discrimination based on other circumstances.Organization: Health care organizations should integrate hygieneethical thinking among its strategic goals. Quality is not only quantifying the data. Personal excellence of health care providers, which is difficult to measure, is the basic building block of organizational excellence and patient satisfaction.Originality: There are not many research studies on perceptionsof discrimination in health care. The article raises the sensitive issue that we should talk more about.Limitations: The survey was conducted on a small sample size. Further research
Molleman, Eric; Broekhuis, Manda; Stoffels, Renee; Jaspers, Frans
Health professionals increasingly face patients with complex health problems and this pressurizes them to cooperate. The authors have analyzed how the complexity of health care problems relates to two types of cooperation: consultation and multidisciplinary teamwork (MTW). Moreover, they have
Awiti, Japheth Osotsi
There is a wide range of actions an individual could take when sick or injured such as self-care, consulting a traditional healer, or seeking treatment from a private or public health care facility. The specific action taken is influenced by individual characteristics, provider characteristics, societal factors, and geographical factors. A key individual characteristic is the ability to afford the required health care. The study examines the effect of poverty on an individual's choice of a health care provider in the event of sickness or injury in Kenya. Using data from the Kenya Integrated Household and Budget Survey carried out between 2005 and 2006, we estimate a multinomial probit model that links an individual's poverty status to the individual's health care provider choice. The choices are classified as none, non-modern, and modern. The model is estimated for four age groups: infants, children aged 1 to 5 years, children aged 6 to 14 years, and adults. We control for the potential endogeneity of poverty status. Our results indicate that for all age groups, the predictors of poverty include large household sizes and longer distances to the nearest health facility. We further find that poverty reduces the probability of visiting a modern health care provider amongst all age groups. Poverty has a negative effect on the individual's demand for modern health care services, holding other factors constant. To encourage the use of modern health care facilities, therefore, requires the pursuit of poverty-reduction strategies. Some of the ways this could be done include lowering the household sizes and reducing the average distance to modern health care facilities.
Soleimani, Farzad; Zenios, Stefanos
To build enabling innovation frameworks for health care entrepreneurs to better identify, evaluate, and pursue entrepreneurial opportunities. Powerful frameworks have been developed to enable entrepreneurs and investors identify which opportunity areas are worth pursuing and which start-up ideas have the potential to succeed. These frameworks, however, have not been clearly defined and interpreted for innovations in health care. Having a better understanding of the process of innovation in health care allows physician entrepreneurs to innovate more successfully. A review of academic literature was conducted. Concepts and frameworks related to technology innovation were analyzed. A new set of health care specific frameworks was developed. These frameworks were then applied to innovations in various health care subsectors. Health care entrepreneurs would greatly benefit from distinguishing between incremental and disruptive innovations. The US regulatory and reimbursement systems favor incrementalism with a greater chance of success for established players. Small companies and individual groups, however, are more likely to thrive if they adopt a disruptive strategy. Disruption in health care occurs through various mechanisms as detailed in this article. While the main mechanism of disruption might vary across different health care subsectors, it is shown that disruptive innovations consistently require a component of contrarian interpretation to guarantee considerable payoff. If health care entrepreneurs choose to adopt an incrementalist approach, they need to build the risk of disruption into their models and also ascertain that they have a very strong intellectual property (IP) position to weather competition from established players. On the contrary, if they choose to pursue disruption in the market, albeit the competition will be less severe, they need to recognize that the regulatory and reimbursement hurdles are going to be very high. Thus, they would benefit
Full Text Available Abstract Background Preventive health care programs can save lives and contribute to a better quality of life by diagnosing serious medical conditions early. The Preventive Health Care Facility Location (PHCFL problem is to identify optimal locations for preventive health care facilities so as to maximize participation. When identifying locations for preventive health care facilities, we need to consider the characteristics of the preventive health care services. First, people should have more flexibility to select service locations. Second, each preventive health care facility needs to have a minimum number of clients in order to retain accreditation. Results This paper presents a new methodology for solving the PHCFL problem. In order to capture the characteristics of preventive health care services, we define a new accessibility measurement that combines the two-step floating catchment area method, distance factor, and the Huff-based competitive model. We assume that the accessibility of preventive health care services is a major determinant for participation in the service. Based on the new accessibility measurement, the PHCFL problem is formalized as a bi-objective model based on efficiency and coverage. The bi-objective model is solved using the Interchange algorithm. In order to accelerate the solving process, we implement the Interchange algorithm by building two new data structures, which captures the spatial structure of the PHCFL problem. In addition, in order to measure the spatial barrier between clients and preventive health care facilities accurately and dynamically, this paper estimates travelling distance and travelling time by calling the Google Maps Application Programming Interface (API. Conclusions Experiments based on a real application for the Alberta breast cancer screening program show that our work can increase the accessibility of breast cancer screening services in the province.
Gu, Wei; Wang, Xin; McGregor, S Elizabeth
Preventive health care programs can save lives and contribute to a better quality of life by diagnosing serious medical conditions early. The Preventive Health Care Facility Location (PHCFL) problem is to identify optimal locations for preventive health care facilities so as to maximize participation. When identifying locations for preventive health care facilities, we need to consider the characteristics of the preventive health care services. First, people should have more flexibility to select service locations. Second, each preventive health care facility needs to have a minimum number of clients in order to retain accreditation. This paper presents a new methodology for solving the PHCFL problem. In order to capture the characteristics of preventive health care services, we define a new accessibility measurement that combines the two-step floating catchment area method, distance factor, and the Huff-based competitive model. We assume that the accessibility of preventive health care services is a major determinant for participation in the service. Based on the new accessibility measurement, the PHCFL problem is formalized as a bi-objective model based on efficiency and coverage. The bi-objective model is solved using the Interchange algorithm. In order to accelerate the solving process, we implement the Interchange algorithm by building two new data structures, which captures the spatial structure of the PHCFL problem. In addition, in order to measure the spatial barrier between clients and preventive health care facilities accurately and dynamically, this paper estimates travelling distance and travelling time by calling the Google Maps Application Programming Interface (API). Experiments based on a real application for the Alberta breast cancer screening program show that our work can increase the accessibility of breast cancer screening services in the province.
The health care system of Chile evolved from rather unique historical circumstances to become one of the most progressive in Latin America, offering universal access to all citizens. Since the advent of the Pinochet regime in 1973, Chile has implemented Thatcherite/Reaganite reforms resulting in the privatization of much of the health care system. In the process, state support for health care has been sharply curtailed with deleterious effects on health services. As Chile emerges from the shadow of the Pinochet dictatorship, it faces numerous challenges as it struggles to rebuild its health care system. Other developing nations considering free-market reforms may wish to consider the high costs of the Chilean experiment.
A myriad of patient dissatisfaction issues stemming from antiquated approaches to primary care access are resulting in the establishment of retail health clinics (RHCs) throughout the country. RHCs are usually located within retail stores or stand-alone pharmacies and are staffed by nurse practitioners (NPs). They offer treatment for colds, coughs, skin rashes, and ear infections along with offering preventive care and physicals. As disruptive innovations, or innovations that offer services to ignored markets, these clinics are siphoning patient care visits away from primary care physicians because of their attention to quick access, affordable prices, and consumer-friendly approaches. In response, family and internal medicine physicians must follow three strategies to secure their patient population as well as attract new patients: build relationships with RHCs through referral networks and NP supervisory agreements, transform the provision of patient access through the development of physician-owned RHCs, and support the concept of the advanced medical home.
Khoury, Muin J.; Lam, Tram Kim; Ioannidis, John P.A.; Hartge, Patricia; Spitz, Margaret R.; Buring, Julie E.; Chanock, Stephen J.; Croyle, Robert T.; Goddard, Katrina A.; Ginsburg, Geoffrey S.; Herceg, Zdenko; Hiatt, Robert A.; Hoover, Robert N.; Hunter, David J.; Kramer, Barnet S.; Lauer, Michael S.; Meyerhardt, Jeffrey A.; Olopade, Olufunmilayo I.; Palmer, Julie R.; Sellers, Thomas A.; Seminara, Daniela; Ransohoff, David F.; Rebbeck, Timothy R.; Tourassi, Georgia; Winn, Deborah M.; Zauber, Ann; Schully, Sheri D.
In 2012, the National Cancer Institute (NCI) engaged the scientific community to provide a vision for cancer epidemiology in the 21st century. Eight overarching thematic recommendations, with proposed corresponding actions for consideration by funding agencies, professional societies, and the research community emerged from the collective intellectual discourse. The themes are (i) extending the reach of epidemiology beyond discovery and etiologic research to include multilevel analysis, intervention evaluation, implementation, and outcomes research; (ii) transforming the practice of epidemiology by moving towards more access and sharing of protocols, data, metadata, and specimens to foster collaboration, to ensure reproducibility and replication, and accelerate translation; (iii) expanding cohort studies to collect exposure, clinical and other information across the life course and examining multiple health-related endpoints; (iv) developing and validating reliable methods and technologies to quantify exposures and outcomes on a massive scale, and to assess concomitantly the role of multiple factors in complex diseases; (v) integrating “big data” science into the practice of epidemiology; (vi) expanding knowledge integration to drive research, policy and practice; (vii) transforming training of 21st century epidemiologists to address interdisciplinary and translational research; and (viii) optimizing the use of resources and infrastructure for epidemiologic studies. These recommendations can transform cancer epidemiology and the field of epidemiology in general, by enhancing transparency, interdisciplinary collaboration, and strategic applications of new technologies. They should lay a strong scientific foundation for accelerated translation of scientific discoveries into individual and population health benefits. PMID:23462917
Jensen, Olaf Chresten
exposures during life at sea and work place health promotion. SEAHEALTH and some of the shipping companies have already added workplace health promotion to occupational health care programs. The purpose of this article is to reinforce this trend by adding some international perspectives and by providing...
Lewit, Eugene M.; And Others
Health care reform needs to assure coverage to all children regardless of income level or illnesses; address benefits, financing, administration, and delivery systems; provide substantial subsidies to low-income families; be equitable for all people; provide better monitoring of child health; protect and strengthen health providers who assist…
centers. The diverse establishments in this group include kidney dialysis centers, outpatient mental health and substance abuse centers, health...without success. Their failure to succeed was partly attributable to a lack of political will to confront major sectors of the health care industry
This podcast features teens who urge US health care professionals to talk to teen patients about pregnancy and contraception. Created: 10/11/2011 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Reproductive Health (DRH). Date Released: 10/11/2011.
J.E.C.M. Aarts (Jos)
textabstractHealth information technology is widely accepted to increase patient safety and reduce medical errors. The widespread implementation makes evident that health information technology has become of a complex sociotechnical system that is health care. Design and implementation may result in
Robinson, J C
This paper analyzes the for-profit transformation of health care, with emphasis on Internet start-ups, physician practice management firms, insurance plans, and hospitals at various stages in the industry life cycle. Venture capital, conglomerate diversification, publicly traded equity, convertible bonds, retained earnings, and taxable corporate debt come with forms of financial accountability that are distinct from those inherent in the capital sources available to nonprofit organizations. The pattern of for-profit conversions varies across health sectors, parallel with the relative advantages and disadvantages of for-profit and nonprofit capital sources in those sectors.
Agarwal, Shanu; Abell, Virginia; File, Thomas M
Nosocomial Legionnaire's disease is most frequently associated with presence of the organism in hospital water systems. Patients are often susceptible as a result of age, underlying comorbidities, or immunosuppression. Prevention focuses on reducing the reservoir within water systems and includes super heating, ultraviolent light, chlorination, silver-copper ionization, and distal filtration. This article reviews the epidemiology of health care-associated Legionnaire's disease, reviews characteristics of several health care-associated outbreaks, and discusses strategies to prevent health care-associated infection. Copyright © 2016 Elsevier Inc. All rights reserved.
Kennedy, Michael H
This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.
Fiorini, Paolo; Ali, Khaled; Seraji, Homayoun
This paper describes the approach followed in the design of a service robot for health care applications. Under the auspices of the NASA Technology Transfer program, a partnership was established between JPL and RWI, a manufacturer of mobile robots, to design and evaluate a mobile robot for health care assistance to the elderly and the handicapped. The main emphasis of the first phase of the project is on the development on a multi-modal operator interface and its evaluation by health care professionals and users. This paper describes the architecture of the system, the evaluation method used, and some preliminary results of the user evaluation.
Full Text Available Background: Leadership development impacts on quality of care and on workplace cultures for staff. Clinical leadership embracing transformational and other collective leadership approaches is a key enabler for developing effective workplace cultures at the micro-systems level. Following the development of a shared purpose and values framework, an internal interprofessional clinical leadership programme was set up to grow a critical community of transformational leaders across one NHS organisation in England. This programme had been unsuccessful in engaging medical doctors for more than two years. Aims and objectives: This paper shares how a dedicated, practice development-based clinical leadership programme set out to support medical doctors across one organisation with their leadership journey, equipping them to become transformational and collective leaders, and facilitators with the skills to develop and sustain person-centred, safe and effective workplace cultures. Methods: Practice development methodology, with its collaborative, inclusive and participative approach to developing person-centred cultures, combined with clinical leadership strategies, formed the basis of the programme. It emphasised the use of active and action learning, drawing on the workplace as the main resource for learning, development and improvement. Self-assessment and collective thinking about clinical leadership, together with collaborative analysis of evaluation data, led to the synthesis of insights through the use of reflection and action planning. Findings: These are presented at two levels: Five individual reflections by authors to illustrate their leadership journeys, which also demonstrate the use of a range of tools and their impact. Insights and learning include recognition of the benefits of peer support and networking, development of a disciplined approach to learning, and self-management A collaborative reflection and critique that embraced a sense of
Consuelo Helena Aires de Freitas
Full Text Available Objective: To discuss the practice of mental health care performed by healthcare professionals from the Family Health Strategy in Fortaleza-CE, Brazil. Methods: This is a critical and reflective study conducted in six Basic Health Units in Fortaleza-Ce. The study subjects were 12 health workers of the following professions: doctor, nurse, community health agents and technical and/or nursing assistant. Semi-structured interviews, systematic observationand questionnaire were used for data collection. The empirical analysis was based on an understanding of the discourses through critical hermeneutics. Results: It was evident that the mental health services are developed by some health workers in the ESF, such as, matrix support, relational technologies, home visits and community group therapy. However, there is still deficiency in training/coaching by most professionals in primary care, due to anenduring model of pathological or curative health care. Conclusion: Mental health care is still occasionally held by some workers in primary care. However, some progresses are already present as matrix support, relational technologies in health care, home visits andcommunity therapy.
According to the U.S. Food and Drug Administration 'the broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalised medicine, and is used by providers and other stakeholders in their efforts to reduce inefficiencies, improve access, reduce costs, increase quality, and make medicine more personalised for patients (FDA 2016). More recently, Paul Sonier, a digital health strategist and founder of the Linkedin digital health group with more than 40,000 members, defined digital health as 'the convergence of the digital and genomic revolutions with health, healthcare, living, and society' (storyofdigitalhealth.com 2016). Copyright the Association for Perioperative Practice.
Full Text Available The activities of health promotion for the students in health care specialties is organized and managed by the teacher process. During the training communication skills are acquired. It is the time for preparing students for work in counseling and patient education, collecting and providing health information - promotive function in the process of care (1. We assumed that these opportunities could be used in our work with children deprived of parental care. We set a goal to explore experiences, attitudes and ideas about students’ participation in health care in health promotion in the community of children and individuals. The study found that students are aware of the social importance of the knowledge acquired during the training and are convinced of the need to support adolescents to develop a responsible attitude towards their own health.
H. Zhang (Hao)
markdownabstractThis dissertation investigates the challenges faced by China around 2010 in two domains – population health and the health care system. Specifically, chapters 2 and 3 are devoted to health challenges, explaining the female health disadvantage in later life and assessing the effect
Safer, Joshua D.; Coleman, Eli; Feldman, Jamie; Garofalo, Robert; Hembree, Wylie; Radix, Asa; Sevelius, Jae
Purpose of Review Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to health care for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them. Recent Findings Current research emphasizes sexual minorities’ self report of barriers, rather than using direct methods. The biggest barrier to health care reported by transgender individuals is lack of access due to lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers and socioeconomic barriers. Summary National research priorities should include rigorous determination of the capacity of the United States health care system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical work force across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps. PMID:26910276
Casate, Juliana Cristina; Corrêa, Adriana Katia
This qualitative research aims to analyze the scientific production about "humane health care/nursing", understanding what views on humanization have been developing. A bibliographic survey was carried out, covering the period from the end of the 1950's until today, in the periodicals Revista Brasileira de Enfermagem, Revista Paulista de Hospitais and Texto e Contexto, examining 42 articles, which were then subject to analysis and integrative synthesis. The issue has been developing from a charitable perspective to the current preoccupation with the valuation of health as a civil right, inserted in a political health project. Articles from all decades reveal the need to invest in workers, valuing the subjective dimension. Nevertheless, humanization receives little attention in education. Care humanization supposes the meeting of subjects who share knowledge, power and experiences, implying political, administrative and subjective transformations.
Joost van Hoof; Eveline Wouters; Sil Aarts; M.E. Nieboer; A.M. van Hout
Perceptions and values of care professionals are critical in successfully implementing technology in health care. The aim of this study was threefold: (1) to explore the main values of health care professionals, (2) to investigate the perceived influence of the technologies regarding these values,
Vance, Connie; Larson, Elaine
To summarize research on leadership in the health care and business literature and to identify the outcomes of leadership on individuals, groups, and organizations. A computerized search and review of research studies was conducted in the health care and business literature from 1970-1999. Studies were categorized and analyzed according to participants, design, primary topic area, and effects or outcomes of leadership. Most of the health care and business literature on leadership consisted of anecdotal or theoretical discussion. Only 4.4% (n = 290) of 6,628 articles reviewed were data-based. Further, the largest proportion of the research (120/290, 41.4%) was purely descriptive of the demographic characteristics or personality traits of leaders. Other studies showed the influence of leadership on subordinates (27.9%). Only 15 (5.2%) of 290 research articles include correlations of qualities or styles of leadership with measurable outcomes on the recipients of services or positive changes in organizations. Research on leadership in the health care and business literature to date has been primarily descriptive. Although work in the social sciences indicates that leadership styles can have a major influence on performance and outcomes, minimal transfer of this work to the health care system is evident. Limited research on leadership and health care outcomes exists, such as changes in patient care or improvements in organizational outputs. In this era of evidence-based practice, such research, although difficult to conduct, is urgently needed.
Aline Vieira Simões
Full Text Available This study aimed to understand the context of health care models and the social control strategies. It is a bibliographic review of critical and reflexive nature based of the references by technical texts, scientific publications and official documents related to public health policies, assisting in the preparation of candidates in the exam for knowledge. It has been selected eleven books and five articles. The material was categorized into three approaches: Historical Context of Public Health Policies, Health Care Models and Social Control Strategies. The results analysis and discussion subsidized the understanding of public health policies, since the implementation of SUS, and regulates health care; however a large country like Brazil, a single model of health care would not be able to meet the demands of health services, which justifies the implementation of various proposals. And, for social control it was possible to understand its influence on public policy changes, where we have identified the health councils and conferences as social control strategies, involving social actors in a critical and constructive role in the process of changing models of care.
McAdoo, Joshua; Irving, Julian; Deslich, Stacie; Coustasse, Alberto
Before 2006, Massachusetts had more than 500 000 residents who lacked health insurance. Governor Mitt Romney enacted landmark legislation requiring all residents to obtain health insurance. Also, the legislation established a health insurance exchange for the purpose of broadening the choices of insurance plans made available to individuals in the state. The purpose of this research was to assess the Massachusetts health care reform in terms of access, cost, and sustainability. The methodology used was a literature review from 2006 to 2013; a total of 43 references were used. Health reform resulted in additional overall state spending of $2.42 billion on Medicaid for Massachusetts. Since the 2006 reform, 401 000 additional residents have obtained insurance. The number of Massachusetts residents who had access to health care increased substantially after the health care reform was enacted, to 98.1% of residents. The Massachusetts health care reform has not saved money for the state; its funding has been covered by Federal spending. However, reform has been sustained over time because of the high percentage of state residents who have supported the state mandate to obtain health care coverage.
More than 2,000 people convened for the ninth annual Global Health and Innovation Conference at Yale University on April 21-22, 2012. Participants discussed the latest innovations, ideas in development, lessons learned, opportunities and challenges in global health activities. Several themes emerged, including the important role of frontline workers, strengthening health systems, leveraging social media, and sustainable and impact-driven philanthropy. Overall, the major outcome of the conference was the increased awareness of the potential of mobile technologies and social enterprises in transforming global health. Experts warned that donations and technological advances alone will not transform global health unless there are strong functioning health infrastructures and improved workforce. It was noted that there is a critical need for an integrated systems approach to global health problems and a need for scaling up promising pilot projects. Lack of funding, accountability, and sustainability were identified as major challenges in global health.
Masud, Abdullah Al; Ahmed, Md. Shahoriar; Sultana, Mst. Rebeka; Alam, S. M. Iftekhar; Kabir, Russell; Arafat, S. M. Yasir; Papadopoulos, Konstantinos
Abstract Background: Rohingya refugees are one of the most vulnerable group due to lack of health care system, personal hygiene, shelter, sanitation and violence. Aim: The present study aims to find out the health problems and health care seeking behavior of rohingya refugee peoples, to identify the socio-demographic information for such exposure group in relation to age, sex, occupation, living areas, to explore the patient's physical, emotional, perceptions, attitudes and environmen...
Full Text Available Innovation has become the symbol of transforming into creative economy and is a process of development for new approaches, technologies and working methods. It is a whole of processes that makes information useable. The innovative capacity of the industry is considered to be one of the most important elements determining international competition. Developing innovation and support systems, providing the infrastructure and inspections required for running them effectively, forming industrial problem solving strategies tailored for individual countries, progressing in accordance with long-term, sustainable, consistent and predictable policies as a whole is the only viable method to implement innovations, which utilize manpower and economic resources, transform and change, use revolutions in life sciences for the good of the public and human welfare and are catalysts for national economy in the light of science. The revolutionary developments in technology in the recent years have caused crucial transformations in healthcare field through their improvements on presentation formats and quality in diagnosis and treatment services. The status of conceptual changes in healthcare industry, which is one of the major sources and utilizers of innovative practices, the place and importance of innovation in healthcare system in Turkey and in the world are synthesized in a holistic approach.
Burston, Sarah; Chaboyer, Wendy; Wallis, Marianne; Stanfield, Jane
This article presents a discussion of three contemporary approaches to transforming care: Transforming Care at the Bedside, Releasing Time to Care: the Productive Ward and the work of the Studer Group(®). International studies of adverse events in hospitals have highlighted the need to focus on patient safety. The case for transformational change was identified and recently several approaches have been developed to effect this change. Despite limited evaluation, these approaches have spread and have been adopted outside their country of origin and contextual settings. Medline and CINAHL databases were searched for the years 1999-2009. Search terms included derivatives of 'transformation' combined with 'care', 'nursing', 'patient safety', 'Transforming Care at the Bedside', 'the Productive Ward' and 'Studer Group'. A comparison of the three approaches revealed similarities including: the foci of the approaches; interventions employed; and the outcomes measured. Key differences identified are the implementation models used, spread strategies and sustainability of the approaches. The approaches appear to be complementary and a hybrid of the approaches such as a blend of a top-down and bottom-up leadership strategy may offer more sustainable behavioural change. These approaches transform the way nurses do their work, how they work with others and how they view the care they provide to promote patient safety. All the approaches involve the implementation of multiple interventions occurring simultaneously to affect improvements in patient safety. The approaches are complementary and a hybrid approach may offer more sustainable outcomes. © 2011 Blackwell Publishing Ltd.
In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference
In a rapidly changing world of health care information access and patients’ rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities. PMID:21164096
Lohr, W David; Jones, V Faye
Children in foster care have exceptional needs due to their histories of abuse, neglect, and increased exposure to violence. The rates of psychiatric symptoms and disorders, such as attention-deficit/hyperactivity disorder, posttraumatic stress disorder, and reactive attachment disorder, are much higher in children in foster care; furthermore, the rate of these children receiving psychotropic medications is 3 times that of children who are not in foster care. Pediatricians, in their role of providing a medical home, play a central role in safeguarding the physical and mental health of these children. By taking a trauma-informed approach to understanding the unique needs and gaps in their health care, pediatricians can improve the mental health and maximize outcome for children in foster care. [Pediatr Ann. 2016;45(10):e342-e348.]. Copyright 2016, SLACK Incorporated.
Cássia Regina de Paula Paz
Full Text Available Objective.Assess the need for incorporation of palliative care in primary health care (PHC through the characterization of users eligible for this type of care, enrolled in a program for devices dispensing. Methods. Descriptive study of case series conducted in 14 health units in São Paulo (Brazil in 2012. It was included medical records of those enrolled in a program for users with urinary and fecal incontinence, and it was applied Karnofsky Performance Scale Index (KPS to identify the indication of palliative care. Results. 141 of the 160 selected medical records had KPS information. Most cases (98.3%, 138/141 had performance below 70% and, therefore, patients were eligible for palliative care. The most frequent pathologies was related to chronic degenerative diseases (46.3%, followed by disorders related to quality of care during pregnancy and childbirth (24.38%. Conclusion. It is necessary to include palliative care in PHC in order to provide comprehensive, shared and humanized care to patients who need this.
de Paula Paz, Cássia Regina; Reis Pessalacia, Juliana Dias; Campos Pavone Zoboli, Elma Lourdes; Ludugério de Souza, Hieda; Ferreira Granja, Gabriela; Cabral Schveitzer, Mariana
Assess the need for incorporation of palliative care in primary health care (PHC) through the characterization of users eligible for this type of care, enrolled in a program for devices dispensing. Descriptive study of case series conducted in 14 health units in São Paulo (Brazil) in 2012. It was included medical records of those enrolled in a program for users with urinary and fecal incontinence, and it was applied Karnofsky Performance Scale Index (KPS) to identify the indication of palliative care. 141 of the 160 selected medical records had KPS information. Most cases (98.3%, 138/141) had performance below 70% and, therefore, patients were eligible for palliative care. The most frequent pathologies was related to chronic degenerative diseases (46.3%), followed by disorders related to quality of care during pregnancy and childbirth (24.38%). It is necessary to include palliative care in PHC in order to provide comprehensive, shared and humanized care to patients who need this.
Graff, Heidi Jeannet; Siersma, Volkert Dirk; Kragstrup, Jakob
after adoption. Our study aimed to theassess health-care utilisation of international adoptees inprimary and secondary care for somatic and psychiatricdiagnoses in a late post-adoption period. Is there an increaseduse of the health-care system in this period, evenwhen increased morbidity in the group...... comprised internationallyadopted children (n = 6,820), adopted between 1994 and2005, and all non-adopted children (n = 492,374) who couldbe matched with the adopted children on sex, age, municipalityand family constellation at the time of adoption. Results: International adoption increased the use...... of allservices in primary care, while in secondary care only fewareas showed an increased long-term morbidity. Conclusion: International adoptees use medical servicesin primary care at a higher rate than non-adoptees someyears after adoption. Excess use of services in secondarycare is also present, but only...
Borman, Karen R
Our health care system continues to undergo transformation in a context of extreme financial pressures. New models of care delivery and financing challenge us to rethink our practices as individual surgeons and as system participants. Understanding the fiscal realities of health care and how we are perceived by health care policy makers can help us to be meaningful participants in channeling reform to create better delivery systems for our patients. This article presents some background information about health care in America with a focus on government programs, and shares insights from my health care policy colleagues.
Bulgiba, A M
In 1998, Malaysia opened its first hospital based on the "paperless and filmless" concept. Two are now in operation, with more to follow. Telemedicine is now being used in some hospitals and is slated to be the technology to watch. Future use of technology in health care will centre on the use of centralised patient databases and more effective use of artificial intelligence. Stumbling blocks include the enormous capital costs involved and difficulty in getting sufficient bandwidth to support applications on a national scale. Problems with the use of information technology in developing countries still remain; mainly inadequate skilled resources to operate and maintain the technology, lack of home-grown technology, insufficient experience in the use of information technology in health care and the attitudes of some health staff. The challenge for those involved in this field will not be in building new "paperless and filmless" institutions but in transforming current "paper and film-based" institutions to "paperless and filmless" ones and changing the mindset of health staff. Universities and medical schools must be prepared to respond to this new wave by incorporating elements of medical/health informatics in their curriculum and assisting governments in the planning and implementation of these projects. The experience of the UMMC is highlighted as an example of the difficulty of transforming a paper-based hospital to a "paperless and filmless" hospital.
The successful implementation and operation of health care networks and the efficient and effective provision of health care services is dependent upon a number of different factors: Telecommunications infrastructure and technology, medical applications and services, user acceptance, education and training, product and applications/services development and service provision aspects. The business model and market development regarding policy and legal issues also must be considered in the development and deployment of telemedicine services to become an everyday practice. This chapter presents the initiatives, role and contribution of the Greek Telecommunications Company in the health care services area and also refers to specific case-studies focusing upon the key factors and issues of applications related to the telecommunications, informatics, and health care sectors, which can also be the drivers to create opportunities for Citizens, Society and the Industry.
... Institute) Sports and Your Eyes (National Eye Institute) Topic Image MedlinePlus Email Updates Get Eye Care updates by email What's this? GO Related Health Topics Eye Diseases Eye Infections Eye Injuries Eye Wear ...
Peyton, Margit Malmmose
Many studies have been conducted on the issue of New Public Management (NPM) and health care, not always quoting directly the philosophies of NPM, but using methods deriving from it. This study seeks to explore the development of studies on NPM in health care since the 1970s. The following research...... questions will be addressed: What types of studies are conducted on NPM in health care and how do these studies relate to the construction of the governable person? What are the changes in these relations and is the acceptance of this nationally dependent? Using Miller and O’Leary’s (1987), “The...... construction of the governable person” as a theoretical framework, all academic articles from AA journals on the issues of NPM, health care and/or hospitals are analyzed....
Cleverley, W O
Product costing is an important management function for today's health care executive. A standard costing approach may be used based on two sets of standards: a standard cost profile and a standard treatment protocol.
Factors influencing health care workers' implementation of tuberculosis contact tracing in Kweneng, Botswana. Lebapotswe Tlale, Rosemary Frasso, Onalenna Kgosiesele, Mpho Selemogo, Quirk Mothei, Dereje Habte, Andrew Steenhoff ...
Mejia, Elisa A; Sattler, Barbara
The health care industry is often overlooked as a major source of industrial pollution, but as this becomes more recognized, many health care facilities are beginning to pursue green efforts. The OR is a prime example of an area of health care that is working to lessen its environmental impact. Nurses can play key roles in identifying areas of waste and presenting ideas about recovering secondary materials. For instance, although infection prevention measures encourage one-time use of some products, nurses can investigate how to reprocess these items so they can be reused. This article examines how the efforts of a Green Team can affect a hospital's waste stream. A health care Green Team can facilitate a medical facility's quest for knowledge and awareness of its effect on the waste stream and environment.
Saulnier, George E; Castro, Janna C; Cook, Curtiss B
Glucose control can be problematic in critically ill patients. We evaluated the impact of statistical transformation on interpretation of intensive care unit inpatient glucose control data. Point-of-care blood glucose (POC-BG) data derived from patients in the intensive care unit for 2011 was obtained. Box-Cox transformation of POC-BG measurements was performed, and distribution of data was determined before and after transformation. Different data subsets were used to establish statistical upper and lower control limits. Exponentially weighted moving average (EWMA) control charts constructed from April, October, and November data determined whether out-of-control events could be identified differently in transformed versus nontransformed data. A total of 8679 POC-BG values were analyzed. POC-BG distributions in nontransformed data were skewed but approached normality after transformation. EWMA control charts revealed differences in projected detection of out-of-control events. In April, an out-of-control process resulting in the lower control limit being exceeded was identified at sample 116 in nontransformed data but not in transformed data. October transformed data detected an out-of-control process exceeding the upper control limit at sample 27 that was not detected in nontransformed data. Nontransformed November results remained in control, but transformation identified an out-of-control event less than 10 samples into the observation period. Using statistical methods to assess population-based glucose control in the intensive care unit could alter conclusions about the effectiveness of care processes for managing hyperglycemia. Further study is required to determine whether transformed versus nontransformed data change clinical decisions about the interpretation of care or intervention results. © 2014 Diabetes Technology Society.
Children and adolescents who enter foster care often do so with complicated and serious medical, mental health, developmental, oral health, and psychosocial problems rooted in their history of childhood trauma. Ideally, health care for this population is provided in a pediatric medical home by physicians who are familiar with the sequelae of childhood trauma and adversity. As youth with special health care needs, children and adolescents in foster care require more frequent monitoring of their health status, and pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services, health care coordination, and advocacy on their behalves. Copyright © 2015 by the American Academy of Pediatrics.
Lavoie-Tremblay, Mélanie; O'Conner, Patricia; Harripaul, Anastasia; Biron, Alain; Ritchie, Judith; Lavigne, Genevieve L; Baillargeon, Sophie; Ringer, Justin; Macgibbon, Brenda; Taylor-Ducharme, Sharon; Sourdif, Jacynthe
Different initiatives have been implemented in healthcare organizations to improve efficiency, such as transforming care at the bedside (TCAB). However, there are important gaps in understanding the effect of TCAB on healthcare teams' work environments. The specific aim of the study is to describe findings regarding the TCAB initiative effects on healthcare teams' work environments. A pretest and posttest study design was used for this study. The TCAB initiative was implemented in fall 2010 in a university health center in Montreal, Canada. The sample consisted of healthcare workers from four different care units. Statistically significant improvement was observed with the communicating specific information subscale from the measure of processes of care variable, and a significant difference was found between the support from colleagues variable, which was higher at baseline than postprogram. The differences for psychological demand, decisional latitude, and effort-reward were not significant. TCAB is an intervention that allows healthcare teams to implement change to improve patients' and families' outcomes. Ongoing energy should focus on how to improve communication among all members of the team and ensure their support. © 2013 Sigma Theta Tau International.
Heins, M.J.; Rijken, P.M.; Schellevis, F.G.; Hoek, L. van der; Korevaar, J.C.
Background: As the number of cancer survivors increases and these patients often experience long-lasting consequences of cancer and its treatment, more insight into primary health care use of cancer survivors is needed. We aimed to determine how often and for which reasons do adult cancer patients contact their Primary Care Physician (PCP) 2-5 years after diagnosis. Methods: Using data from the Netherlands Information Network of Primary Care (LINH), we determined the volume and diagnoses made...
Heins, M.J.; Rijken, P.M.; Schellevis, F.G.; Hoek, L. van der; Korevaar, J.C.
Background: As the number of cancer survivors increases and these patients often experience longlasting consequences of cancer and its treatment, more insight into primary health care use of cancer survivors is needed. Research question: How often and for which reasons do adult cancer patients contact their Primary Care Physician (PCP) 2-5 years after diagnosis. Methods: Using data from the Netherlands Information Network of Primary Care (LINH), we determined the volume and diagnoses made dur...
In all areas of nursing, the concept of caring encompasses the core of our practice and is the outcome of skilled practitioners. In occupational health nursing (OHN) it is no different. 'Caring' has been described by many authors, used in theoretical models of nursing and forms the basis of much research. This paper looks at the provision of care in the OH setting within Northern Ireland, with particular reference to problems which have arisen from the troubles.