The effect of organizational level and practice area on managerial work in hospital dietetic services

All areas of practice in hospital dietetic services include a management component; however, the nature of the managerial role in various areas of dietetic practice has not been identified clearly. The definition of dietetic practice in the Conceptual Framework for the Profession of Dietetics supports the importance of managerial skills. The effect of organizational level and practice area on managerial activities and roles of professional staff in hospital dietetic services was examined in this study. The nationwide sample included professionals in hospitals with 300+ beds. A total of 3,280 dietetic professionals participated. Five groups were defined: low administrative, low clinical, middle administrative, middle clinical, and upper administrative. Mintzberg identified 10 managerial roles and categorized them as interpersonal, informational, or decisional. The 10 roles were used as the basis for developing an 80-item instrument on which respondents rated each item for importance and time demand. Perceived importance of managerial activities tended to be greater at higher organizational levels. The managerial aspects of the lower clinical and upper administrative position were the most clearly defined. The lower clinical group tended to rate all of the managerial roles as significantly less important than did those in other positions; however, the middle clinical position included a substantial managerial responsibility.     

Dimensions of clinical competence as conceptualized by medical school faculty

This study identified dimensions of clinical competence underlying faculty ratings of fourth-year student performance in a standardized patient examination and assessed the impact of these dimensions on faculty pass/fail decisions. Content review coupled with exploratory factor analysis was used to group 17 of 25 specific behavioral rating categories into four homogeneous clusters. Confirmatory factor analysis refined the clusters into four unidimensional scales that included 14 of the original ratings. The dimensions reflected relating to the patient, problem-solving skills, medical history skills, and physical examination skills. The factor structure was cross-validated in a separate data set. Logistic regression indicated problem solving was the only independent predictor of a student passing the exercise.     

Managerial functions of college and university foodservice managers

This study examined managerial roles in college and university foodservice at three organizational levels. The study population included foodservice managers at National Association of College and University Food Services (NACUFS) member schools with a minimum annual budget of +3 million. The 999 managers from 80 colleges and universities who participated were categorized into three groups: assistant, associate, or director of foodservice; unit manager; and manager reporting to unit manager. They rated 51 activity statements on importance and time demand. Maintaining standards of quality was rated most important and most time demanding by all three groups of managers. Perceived importance and time demand of activities increased as managerial level increased. Activity statements were categorized into Mintzberg's 10 managerial roles. Significant differences in importance and time demand ratings among the three managerial groups were indicated for all 10 roles. However, perceived importance and time demand of roles increased as managerial level increased with two exceptions. Disturbance handler and leader roles were rated more time consuming by lower level managers.     

Characteristics of effective health care managers

This article provides an overview of traditional and contemporary management theories. Concerns, characteristics, and skills of effective managers are also presented. Further, a self-assessment (survey) of 7 highly effective health care managers in a South Georgia community was conducted to determine their ratings on 6 management indices. The assessment or Scale of Transformational Leadership uses a Likert-type scale to allow for the evaluation of managers. The scale contains 6 management elements for assessment: attention, meaning, trust, self, vision, and feeling. Individual ratings and group summary skills rating are presented. Findings revealed the order of managerial importance of the elements as follows (from highest to lowest): Management of Trust, Management of Attention, Management of Self, Management of Feeling, Management of Meaning, and Management of Risk. As a second tier, the final ratings are corroborated by health care management interns.     

Competencies for population-based clinical managers: A survey of managed care medical directors

Background: The evolution of American health care into integrated systems of delivery and finance requires a specialized set of population-based skills for physicians. The field of preventive medicine represents one source of this expertise. Specific competencies for the emerging area of managerial medicine have not been well delineated.Methods: Using concept documents from the Residency Review Committee for Preventive Medicine and the American Board of Preventive Medicine, a list of proposed competencies for managerial medicine was identified. Surveys were mailed to medical directors of all members of the American Association of Health Plans and to a random sample of diplomates of the American Board of Preventive Medicine. Respondents were asked to rate the importance of these competencies for a population-oriented clinician manager.Results: Areas rated highly by medical directors included health services research (including outcomes research), quality assurance and improvement, health risk assessment and reduction, programmatic skills, and clinical preventive skills. Responses from preventive medicine specialists were similar, but placed lower emphasis on these skills.Conclusion: Despite its limited response rate, this survey may be useful in the implementation of specialty training in managerial medicine. Residency training programs may choose to emphasize specific content areas that reflect the priorities expressed by physicians actively involved in management.     

Self-perceived competence of Canadian public health nutritionists

This study investigated the self-perceived competence of public health nutritionists employed in provincial and municipal/regional departments of health in Canada. One hundred and fifty-three (78%) of all eligible Canadian public health nutritionists responded to a mailed questionnaire. Nutritionists were asked to rate their level of competence on 10 competency scales and to indicate sources of their knowledge and skill development. Respondents gave the highest ratings to their interpersonal and communication skills and the lowest ratings to their research and information management abilities. T-tests showed that nutritionists who had completed a postgraduate degree felt significantly more competent in their managerial and administrative (p less than .05), organizational (p less than .01), program planning/evaluation (p less than .001), research (p less than .001), and supervisory/leadership/facilitating skills (p less than .05) than those with only a bachelor's degree. One-way ANOVA revealed significant effects of geographical location for eight competency scales. The results of this study identify continuing education needs and have implications for the graduate education of public health nutritionists.     

Management development: a study of nurse managerial activities and skills

This study discusses an activity competency model that may be used to investigate the perceived importance of managerial activities and skills required by three levels of nurse managers (top, middle, and supervisory management). Our findings indicate that the importance of nurse managerial activities differs significantly according to the level of nurse management. A set of critical managerial activities and skills/knowledge needs for each level of nurse managers was identified in the study. These findings provide guidelines for nursing-management development programs, training, and career planning. They also can serve as a guideline for recruiting and selecting an effective nurse manager.     

What administrators look for in their directors of pharmacy

A questionnaire was sent to 160 hospital administrators in Southern California. The questionnaire sought to determine whether directors of pharmacy are good managers, how much time directors spend on administrative tasks, and which managerial skills are most valuable for a director of pharmacy to possess. The results of that questionnaire and a series of recommendations are presented.     

Physicians' and nurses' reactions to electronic medical records. Managerial and occupational implications

Aims to understand the managerial implications of the perceptions hospital physicians and nurses hold toward the introduction of electronic medical records (EMRS). In-depth interviews were used with 18 hospital physicians and eight nurses from several different hospital wards at a large government-run, university-affiliated hospital in Israel, where EMRs were gradually introduced over the last 20 years. Physicians identified six different domains of impact. Senior physicians, most of whom held managerial roles, tended to emphasise managerial outcomes and to view these as positively affecting their organisations. Junior doctors emphasised mostly negative occupational effects of the EMR on their work--including limits to professional autonomy, heavier administrative burdens, and reinforcement of existing professional hierarchies. Nurses identified different domains and saw benefits for quality and administration of patient care.     

卫生管理干部胜任素质现状测评分析

研究通过核检表法、行为事件访谈法(BEI)及专家咨询法,对全国范围的139名卫生管理干部进行调查研究,构建了包含决策能力、沟通协调能力、计划组织能力、团队领导力、逻辑思维能力、应变能力及政策法律意识7项素质在内的卫生管理干部胜任力模型。采用行政能力测验及情境判断测验,对山东某市221名卫生管理干部进行了胜任素质测评,总体平均分数显示,该市卫生管理干部责任心、应变能力较强,团队领导力、计划组织能力、政策法律意识居中,沟通协调能力、逻辑思维能力稍弱,其中54%的测评者达到了优秀水平(7分以上),仅8%测评者成绩较低(低于5分)。提示在今后的卫生管理干部培训中,应重点加强沟通协调能力及逻辑思维能力的培训和训练,同时应根据不同卫生管理干部的能力水平开展特异性、针对性的培训培养,对不能胜任管理岗位的人员在加强培训的同时,也可以将其调配到合适的岗位上,使其在工作中扬长避短,最大程度的发挥个人潜能,体现个体价值。     

Nurses' Perceptions of Pediatric Nursing Functions

The purpose of this study was to describe nurses' perceptions of the importance of pediatric nursing functions and to determine if there were differences in perceptions of nurses in managerial clinical and teaching positions Subjects were 125 pediatric nurses in managerial clinical and teaching positions Respondents were asked to rate the importance of 43 nursing functions on a 9-point scale ranging from highly important to not at all important Mean ratings of pediatric nursing functions were determined and one-way analyses of variance performed. The five nursing functions perceived to be most important were, in order of ranking (a) providing emotional support of children (b) recognizing significant physical deviations, (c) implementing nursing interventions (d) preparing children psychologically for procedures and surgery and (e) identifying nursing problems Significant differences were found between groups in perceptions of the importance of 23 nursing functions mainly in the areas of psychosocial care teaching and nursing process Most differences were between the teaching and managerial groups or between teaching and the managerial and clinical groups combined Differences in perceptions of the importance of a number of nursing functions though not great suggest a need for more dialogue between managers teachers and clinicians.     

Nurses' Perceptions of Pediatric Nursing Functions

The purpose of this study was to describe nurses' perceptions of the importance of pediatric nursing functions and to determine if there were differences in perceptions of nurses in managerial clinical and teaching positions Subjects were 125 pediatric nurses in managerial clinical and teaching positions Respondents were asked to rate the importance of 43 nursing functions on a 9-point scale ranging from highly important to not at all important Mean ratings of pediatric nursing functions were determined and one-way analyses of variance performed. The five nursing functions perceived to be most important were, in order of ranking (a) providing emotional support of children (b) recognizing significant physical deviations, (c) implementing nursing interventions (d) preparing children psychologically for procedures and surgery and (e) identifying nursing problems Significant differences were found between groups in perceptions of the importance of 23 nursing functions mainly in the areas of psychosocial care teaching and nursing process Most differences were between the teaching and managerial groups or between teaching and the managerial and clinical groups combined Differences in perceptions of the importance of a number of nursing functions though not great suggest a need for more dialogue between managers teachers and clinicians.     

不同年龄段医院管理人员对管理能力重视程度的调查分析

目的了解不同年龄段医院管理人员对管理能力的重视程度。方法分别对25～34岁、35～44岁、45～54岁不同年龄段的我院行政后勤部门管理人员进行问卷调查。结果不同年龄段医院管理人员对反映管理人员能力的管理学原理、法律与法规、卫生政策、人力资源管理、质量管理知识指标;工作作风、职业品质素质指标;发现问题、综合分析、沟通协调、自我学习技能指标的重视程度有差异。结论医院应坚持以能力、业绩为导向,培养具备发现问题、综合分析、沟通协调和自我学习能力的医院管理人才。     

The Influence of Facilitator and Facilitation Characteristics on Participants' Ratings of Stepfamily Education

We examine the relative importance of facilitator and facilitation characteristics on participant ratings of a stepfamily education program. Data from 48 facilitators and 598 participants suggest that quality facilitation is more meaningful to participants than whether facilitators have comparable demographic characteristics or life experiences. Hierarchical regressions identified time management effective use of personal experiences, and clear explanation of material as key facilitation skills. Popular assumptions about participant‐facilitator similarity and implications for programming are discussed.     

A Preliminary Study of Social Issues in AIDS Prevention Among Adolescents

Educational efforts to prevent the spread of AIDS require a combination of accurate information and the application of that information to personal behavior. In this preliminary study, a scale was developed to evaluate the social and interpersonal skills of adolescents in AIDS-related and non-AIDS-related interactions. The instrument was administered to 101 Australian students in grades 10 and 11 of an urban high school. Findings indicate ratings of AIDS-related activities of the adolescents were not significantly different from their other social activities, suggesting levels of comfort and assertiveness among adolescents in AIDS-related activities can be modified. Students felt most anxious about problems with sexually transmitted diseases or drug use, suggesting difficulty in dealing with the possible public disclosure of these stigmatized conditions. Data suggest both individual and group scores among adolescents may improve on the five dimensions of the scale following interventions to promote social and interpersonal skills designed to apply knowledge obtained from AIDS education.     

Using standardized patients to assess the interpersonal skills of physicians: six years' experience with a high-stakes certification examination

Communication and interpersonal skills are essential elements of a physician's clinical expertise. Since 1998, the interpersonal competencies of over 37,000 internationally-trained physicians have been assessed as part of the Educational Commission for Foreign Medical Graduates (ECFMG) Clinical Skills Assessment (CSA). Standardized patients (SPs) provided ratings of interpersonal skills along 4 dimensions: skills in interviewing and collecting information; skills in counseling and delivering information; rapport; and personal manner. The content of the rating scale, the development and implementation of training materials and procedures, and the psychometric characteristics of the measures are described. Data from over 400,000 simulated patient encounters were analyzed. Correlations with other measures supported the construct validity of the assessment. A generalizability study showed that the ratings were reproducible over encounters. Analysis of individual SP ratings indicated that they were consistent in their application of the scoring rubric. Overall, the findings indicate that SPs, with proper training and a benchmarked scoring rubric, can provide accurate and defensible ratings of physicians' interpersonal skills. These results may also generalize to other clinical skills assessments, or other evaluations that employ raters to judge communication abilities.     

Evaluación de un programa piloto promotor de habilidades parentales desde una perspectiva de salud pública

ObjectiveTo evaluate the process and the results of the pilot phase of the Parenting skills development programme for families (PSP), an evidence-based strategy to promote positive parenting skills in socio-educational and community settings.MethodsBefore-after quasi-experimental design without a control group for the evaluation of the pilot phase of the PSD carried out in Barcelona (Spain) between October 2011 and June 2013. Eleven groups were established with the participation of 128 parents and 28 professionals. The intervention consisted of 10 or 11 sessions. Information was collected through questionnaires for parents and in-depth individual or group interviews for professionals. Parenting skills were identified through a questionnaire with six dimensions. The situation before the intervention (T0) and immediately after (T1) was compared.ResultsIn T1 the number of participants decreased to 83 (retention = 64.8%). Participants showed a high level of satisfaction with different dimensions of the program. On a maximum score of 10, the satisfaction of professionals was 8.7. Several key aspects and areas for improvement were identified for the future of the intervention. The quantitative analysis revealed improvements in all parenting skills dimensions and these improvements were consistent with the results of the qualitative analysis.ConclusionsThe results of the pilot phase of this program suggest that a universal intervention on parenting skills can improve wellbeing among parents.     

Organisation turnover among registered nurses: an exploratory model.

In light of current concerns over nursing shortages and productivity, turnover among hospital nurses has assumed renewed importance as a managerial issue. This study examines the thesis that organisation of hospital work is a determinant of voluntary turnover among registered nurses. This perspective differs from previous work in this area in that both turnover and its determinants are conceptualised at the organisational rather than individual level, thus opening the way for administrative intervention to reduce turnover. The conceptual model is tested using multiple regression techniques on a sample of 310 community hospitals. Results suggest the importance of administrative work structures and the professionalisation of the workforce as contributors to higher turnover.     

Using Standardized Patients to Assess the Interpersonal Skills of Physicians: Six Years' Experience With a High-Stakes Certification Examination

Communication and interpersonal skills are essential elements of a physician's clinical expertise. Since 1998, the interpersonal competencies of over 37,000 internationally-trained physicians have been assessed as part of the Educational Commission for Foreign Medical Graduates (ECFMG®) Clinical Skills Assessment (CSA®). Standardized patients (SPs) provided ratings of interpersonal skills along 4 dimensions: skills in interviewing and collecting information; skills in counseling and delivering information; rapport; and personal manner. The content of the rating scale, the development and implementation of training materials and procedures, and the psychometric characteristics of the measures are described. Data from over 400,000 simulated patient encounters were analyzed. Correlations with other measures supported the construct validity of the assessment. A generalizability study showed that the ratings were reproducible over encounters. Analysis of individual SP ratings indicated that they were consistent in their application of the scoring rubric. Overall, the findings indicate that SPs, with proper training and a benchmarked scoring rubric, can provide accurate and defensible ratings of physicians' interpersonal skills. These results may also generalize to other clinical skills assessments, or other evaluations that employ raters to judge communication abilities.     

What patients want: A content analysis of key qualities that influence patient satisfaction

We sought to identify key qualities of healthcare that influence patient appraisal of satisfaction with primary care. An Internet survey of patients was used to collect anonymous ratings of physicians on several dimensions of healthcare experiences, as well as comments about aspects of care that were excellent and those that could be improved. Qualitative data analysis was used to discern content clusters and relate them to high and low ratings of patient satisfaction. Content analysis revealed that patients perceive and value at least seven domains of healthcare in defining outstanding quality (access, communication, personality and demeanor of provider, quality of medical care processes, care continuity, quality of the healthcare facilities, and office staff. All seven were cited as reasons for rating physicians as excellent, while four domains (communication, care coordination, interpersonal skills, and barriers to access) drove negative ratings. We conclude that patient satisfaction ratings are highly influenced by a core of communication and follow-up care. Physicians who do not possess these traits will not likely attain high ratings, while having these core traits does not necessarily ensure high patient satisfaction.