HMO members and clinicians rank health education needs.

Before expanding a health education program, the staff of the George Washington University Health Plan conducted a needs assessment of members. Patients in the HMO''s adult care and parents in pediatric waiting areas answered survey questions, and a random sample of members was polled by mail. Patients rated their interest in a list of 45 topics, and plan clinicians chose from the same list topics which "would be of greatest help in your practice." Anxiety/stress was the most popular topic among patients and those who responded by mail. Depression, physical fitness, CPR, and nutrition also rated high. Only 4 topics appeared among the top 10 choices of both plan members and clinicians. After discussion of the patients'' choices, the clinicians were asked, several weeks later, to rate the topics again. Clinicians'' choices in the second round much more closely approximated the choices of the members. The most frequently chosen method of instruction was "written material," although videotape and other, more expensive media were also listed. When seminars geared to the members'' top choices in the survey were offered, the response was so enthusiastic that additional seminars--a total of 12 in 6 weeks--were held.     

Assessment of continuing education preferences in Illinois

A survey of Illinois Dietetic Association members was done to determine demographic characteristics and continuing education (CE) preferences. Nine hundred and seven usable questionnaires (39%) were returned. Preferences were related to present position, age, number of years in job, year of highest degree, and route to ADA membership. A high preference for nutrition care topics was associated with a high number of respondents employed as clinical dietitians. Members from the Chicago metropolitan area differed from other members in preferences for CE topics and reasons for nonattendance at CE programs.     

Better information for the board

Healthcare managers are making quicker, riskier decisions in an increasingly competitive and regulated environment. Questions have been raised regarding the accountability and performance of boards of these organizations, as board members are not always selected based on their competencies to guide such decisions. Adapting mission and strategy and monitoring organizational performance require information that boards get mostly from management. The purpose of this study was to examine the information that boards regularly get to carry out their functions. I obtained board documents from four not-for-profit hospitals and health systems in different boroughs of New York City. At each institution, I conducted one-hour interviews with at least three board members and three top managers. I also attended at least one board or executive committee meeting and one additional meeting, usually of the finance committee. Principal findings were that the boards get too much data, the same data that management gets, and little comparative data on performance of similar benchmarked organizations. Board members and managers are satisfied with the information that board members get and have no plans to improve their system of shaping, or the quality of, information. Key recommendations to boards and managers are: (1) boards must take greater responsibility for identifying the information that they get and how they wish to get it, (2) managers must ensure that measurable objectives are developed, against which organizational performance can be evaluated, (3) boards must get information that is targeted and shaped to better fit board functions, (4) managers must develop information sets for main service lines, (5) boards must get information on the expectations and satisfaction levels of key stakeholders, (6) boards must get better and more focused information on performance of benchmarked institutions, and (7) boards must get less hospital operating data on a monthly basis.     

Innovation and motivation in public health professionals

OBJECTIVES: Innovations in public health services promote increases in the health status of the population. Therefore, it is a major concern for health policy makers to understand the drivers of innovation processes. This paper focuses on the differences in behaviour of managers and front-line employees in the pro-innovative provision of public health services. METHODS: We utilize a survey conducted on front-line employees and managers in public health institutions across six European countries. The survey covers topics related to satisfaction, or attitude towards innovation or their institution. We undertake principal components analysis and analysis of variance, and estimate a multinomial ordered probit model to analyse the existence of different behaviour in managers and front-line employees with respect to innovation. RESULTS: Perception of innovation is different for managers and front-line employees in public health institutions. While front-line employees' attitude depends mostly on the overall performance of the institution, managers feel more involved and motivated, and their behaviour depends more on individual and organisational innovative profiles. CONCLUSION: It becomes crucial to make both managers and front-line employees at public health institutions feel participative and motivated in order to maximise the benefits of technical or organisational innovative process in the health services provision.     

Mission statement perception: Are we all on the same wavelength? A case study in a Flemish hospital

BACKGROUND: Although it is widely recognized that the effectiveness of mission statements is contingent upon the extent to which they are communicated to the organization's members, there is virtually no literature on how organizational members perceive the mission statement. PURPOSES: To address these shortcomings, a research project was set up to seek (a) to assess how managers and nonmanagers perceive the mission statement and (b) to determine if there is a perception gap between both groups. METHODOLOGY/APPROACH: In total, 102 nurses, nurse managers, and senior managers in a 217-bed Flemish hospital filled up a questionnaire, based on the Competing Values Framework for Managerial Communication, to assess their perception of the organizational mission statement. FINDINGS: There is a mission statement perception gap between managers and nonmanagers. The scores of the management group are, in almost all cases, significantly higher. These findings suggest that managers have a more positive attitude toward the mission statement. PRACTICE IMPLICATIONS: To optimize the impact of the mission statement, managers should measure the perception of the mission statement and try to remediate possible mission statement perception gaps. The Competing Values Framework for Managerial Communication is offered as a tool to assess (a) the presence, (b) the direction, and (c) the intensity of possible mission statement perception gaps.     

National survey: Risk managers' attitudes and experiences regarding patient safety and error disclosure

Risk managers can play a vital role in promoting transparency in health care and enhancing patient safety. However, little is known about risk managers' patient safety attitudes and experiences. Therefore, the authors surveyed members of the American Society for Healthcare Risk Management, the largest organization of health care risk managers in the country. These risk managers identified important areas for improvement in the reporting and disclosure of medical errors.     

The experiences of risk managers in providing emotional support for health care workers after adverse events

Risk managers often meet with health care workers who are emotionally traumatized following adverse events. We surveyed members of the American Society for Health care Risk Management (ASHRM) about their training, experience, competence, and comfort with providing emotional support to health care workers. Although risk managers reported feeling comfortable and competent in providing support, nearly all respondents prefer to receive additional training. Risk managers who were comfortable listening to and supporting health care workers were more likely to report prior training. Health care organizations implementing second victim support programs should not rely solely on risk managers to provide support, rather engage and train interested risk managers and provide them with opportunities to practice.     

The effect of retail store managers on Aboriginal diet in remote communities

Abstract: Key nutrient densities of the diet of two remote northern coastal Aboriginal communities were measured using the store-turnover method during the periods that three store managers were responsible for each store respectively. Individual store managers were a greater determinant of nutrient density than the community itself. Furthermore, nutrient densities tended to be highest in both communities when their stores were administered by one particular store manager. The results support the notion that store managers wield considerable power over the food supply of remote Aboriginal communities, and raise questions concerning the ability of Aboriginal community members to influence their own food supplies in retail stores. However, the study also confirms that store managers can be important allies in efforts to improve Aboriginal dietary intake.     

Learning the developments in EMTALA jurisprudence through the lens of John West's “case law update”

This article covers three recurring issues concerning the federal law known as the Emergency Medical Treatment and Labor Act (EMTALA) that keep popping up in John West's Case Law Update case updates, and consistently bedevil hospital risk managers. First, what exactly constitutes an “appropriate” medical screening examination; second, when is a patient actually “stabilized’ under EMTALA; and third, does the EMTALA obligation really “disappear” when a patient is admitted to the hospital? The editors wanted to analyze topics that challenge the courts to “get it right” on the law and that drive risk managers crazy. EMTALA is the “poster child” for such a topic.     

Stress management. What do you do to relax?

Stress has been identified as a leading cause of disease in our society. The dynamics of the healthcare administration profession cause managers to be easy victims of this contemporary disorder. Many people realize that an antidote to stress is leisure-time hobbies. To find out what managers do with their leisure time, MGMA conducted an informal poll of Association members. Their responses were enlightening, interesting, and sometimes amusing. Some managers share similar interests, while some are quite unique.     

Addressing the problem of rural community engagement in healthcare service design

Policy suggests that health service providers should plan services with communities. In remote and rural areas this is sometimes ineffective, resulting in resistance to change. An action research project investigated best practise in rural community engagement. As a result a planning 'game' was developed that uses a number of types and levels of cards and allows community members, as part of a process of engagement, to express their priorities and designs in a form that is directly usable by health service managers. The game is a unique community engagement resource in that it combines the priorities of the community (including their experiences of using services) with existing service data. It allows community members and service managers to apply their priorities for services to a healthcare budget to identify appropriate and affordable ways of providing safe local services.     

Payer-based case management: perspectives on managing brain-injured patient

As the payer environment is carved into many segments, each with its own accountability relative to its financial liability, family members, providers, and even other case managers often find it difficult to comprehend the perspectives of the various parties represented. Indeed, one brain injury case I recently evaluated had four payer case managers: one from the patient's health plan, one from a disease management program for his premorbid diabetes, and two from Medicaid-sponsored programs for the disabled. For payer-based case managers, the ubiquitous case manager role confusion compounds product unfamiliarity.     

Rurality, remoteness and the change process: evidence from a study of maternity services in the north of Scotland.

There is a wealth of material on 'how to do' change plus empirical work revealing change process complexity. In health care, the relevance of context is highlighted, but studies of rural health-care change have focused on community impacts. There is little to inform health-care managers of how remoteness and rurality impact upon change processes. This study considered Scottish maternity units and aimed to identify issues in the change process associated with rurality and remoteness. Six units were purposively selected and 131 interviews were conducted with managers, staff and community members over 15 months. Analysis induced themes pertinent to remoteness and rurality. These included: perceived 'distance' between senior managers imposing change and the wider community of staff and residents; perceptions of community vulnerability; and tensions arising from working in small teams and living in small communities. The study provides useful insights for rural managers at a time of considerable service reconfiguration.     

Office managers' perception of stress, control, and satisfaction: a comparison between primary care and specialty practices

Perception of stress, control, and satisfaction was measured by office managers in medical practices. Office managers spend enormous amounts of time each day handling difficult interpersonal issues among staff physicians, and patients. As a group, physician disruptions were the most prevalent per day. Other staff members were considered the most stressful by rank order. Significant differences were discovered between primary care practices versus specialty practices in the areas of interactions with physicians.     

Phone technology systems help practices communicate with patients

Modern computer technology provides practices with modalities to communicate directly with patients at low cost. This article describes several TeleVox systems that allow managers to confirm appointments, issue recalls, and transmit laboratory and other data. Other systems allow patients to leave messages for their providers more directly and also allow practices to supply educational information on medical topics while patients are on hold.     

Multistate nurse licensure in case management

To encourage case managers and CM employers to support compliance with multistate nursing licensure, the Case Management Society of America (CMSA) board of directors has revised an earlier position statement on multistate nursing licensure in case management. According to CMSA President Susan Rogers, RN, BSN, CCM, "CMSA's fundamental position on this topic remains unchanged. What's different is a more assertive position in support of appropriate safeguards for our members and case managers nationwide."     

完善医疗卫生单位领导干部工作绩效考核与激励机制研究

重点探讨了目前医疗卫生单位领导干部绩效考核的指标体系、考核方法和激励机制。从调查结果分析发现，建立考核指标体系必须考虑目前实际情况，又比较符合现代医疗卫生单位管理的内在要求；考核方法必须有利于全面系统的干部管理，又简便可行不繁琐；激励机制建立必须有一定强度的激励作用，又能被领导干部和广大医务员工所接受。     

The cultural expression of death and dying

Death and dying are universal experiences for people from all cultural groups. This collective experience is intertwined with issues involving mind, body, and spirit in the context of each person's unique culture. Case managers can be instrumental in teaching other members of the health care team regarding the cultural issues involved in the dying process of terminally ill clients. Successful management of the process for clients and the people important to them requires a culturally competent approach. Moreover, the managers need to understand the cultural process of dying and the death process both for themselves and their clients.     

Communication plays key role in OB patient expectations

Obstetrics is a medical specialty with high profe sional liability exposure. Every aspect of an adverse OB outcome has become an opportunity for a legal review. Common root causes in adverse outcomes include communication failure, poor teamwork, and system failures. Indeed, poor communication is a significant factor in OB‐related malpractice claims. This excerpt from the booklet Risk Management Pearls for Obstetrics highlights those causes (particularly poor communications) and provides strategies to address them.     

Practice paper of the American dietetic association: nutrient density: meeting nutrient goals within calorie needs

Practice Papers are evaluative summaries of scientific and/or evidence-based topics. They are meant to provide key opportunities for critical reasoning on timely topics and quality improvement in dietetics practice and to include peer-reviewed perspectives from content practitioners and other experts.How does a practice topic become a Practice Paper? Proposals may be generated by any member of the American Dietetic Association via submission of a topic identification proposal, which may be obtained by contacting ADA headquarters at 800/899-4835 or ppapers@eatright.org. The Association Positions Committee oversees the development of Practice Papers and welcomes proposals from members.