Transitional funding: changing Ontario's global budgeting system

In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of Health and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient-level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting.     

Herbal medicine: the science of the art

In the last 50 years science has provided new perspectives on the ancient art of herbal medicine. The present article discusses ways in which the evidence base for the professional use of 'Western' herbal medicine, as therapy to treat disease, known as phytotherapy, can be strengthened and developed. The evidence base for phytotherapy is small and lags behind that for the nutritional sciences, mainly because phytochemicals are ingested as complex mixtures that are incompletely characterised and have only relatively recently been subject to scientific scrutiny. While some methodologies developed for the nutritional sciences can inform phytotherapy research, opportunities for observational studies are more limited, although greater use could be made of patient case notes. Randomised clinical trials of single-herb interventions are relatively easy to undertake and increasing numbers of such studies are being published. Indeed, enough data are available on three herbs (ginkgo (Ginkgo biloba), St John's wort (Hypericum perforatum) and saw palmetto (Serenoa repens)) for meta-analyses to have been undertaken. However, phytotherapy is holistic therapy, using lifestyle advice, nutrition and individually-prescribed mixtures of herbs aimed at reinstating homeostasis. While clinical experience shows that this approach is applicable to a wide range of conditions, including chronic disease, evidence of its efficacy is scarce. Strategies for investigating the full holistic approach of phytotherapy and its main elements are discussed and illustrated through the author's studies at the University of Reading.     

Programme budgeting: an aid to planning and priority setting in health care

Programme budgeting can assist in overcoming some of the current problems besetting health care planning and management. In particular, health services suffer from lack of (i) explicit objectives; (ii) comprehensive overviews; (iii) knowledge of production functions; (iv) incentives for efficiency; and (v) inappropriate budgeting structures. Programme budgeting while not in itself capable of overcoming all these problems can create an information framework which first highlights but secondly fosters amelioration of these problems. In essence programme budgeting links outputs and inputs by health care programme. This facilitates monitoring, planning, control and the fostering of evaluation. Two examples of the use of programme budgets are presented.     

Enteral feeding: the art and the science.

Enteral feeding (TEN) is the preferred method for hospitalized patients requiring nutrition support. However, real and perceived barriers to implementation exist, with gastrointestinal (GI) intolerance being the most common. The purpose of this article is to identify common GI obstacles to effective TEN and to review current practices of TEN delivery and evidence to support such practices. The article reviews the GI anatomy and physiology that affect TEN practices and also identifies related evidence on the most common GI barriers limiting effective TEN delivery. Suggested solutions are provided.     

Programming, budgeting, and control in health care organization: the state of the art.

The planning, budgeting, and controlling processes (PBCP) largely subsume all of the planning and controlling activities of an organization. This paper discusses these activities within the context of a single management control system, focusing on three topics. First, a brief historical perspective of management concerns which relate to PBCP is presented and several important external pressures currently imposed on the health care industry are discussed. Second, normative models of the processes--programming, budgeting, and controlling--are presented. The discussion focuses on the elements and relationships of these processes, and numerous references to the literature are provided. Third, several issues related to the gap between the state of the art in PBCP for hospitals and the current state of practice are discussed.     

The professional socialisation of midwives: Balancing art and science

Mastery of esoteric knowledge is one of the central features assigned by sociologists to fully professionalised service occupations, together with an orientation towards public service. There are, nevertheless, different views about the best way in which this education and socialisation can be provided for new recruits for practitioner roles. Some maintain that the university provides an ideal training ground. Critics of this view, however, call for a rejection of "university diploma mills' and a return to the type of apprenticeship socialisation common during the premodern era. This paper tests the usefulness of these perspectives in understanding the occupational socialisation of Newfoundland and Labrador midwives. Three major styles of training - traditional apprenticeship, vocational schooling and university education - can be discerned. In comparison to both apprenticeship and academic styles of occupational socialisation, only vocational training nicely blended the art and science of midwifery to produce competent and committed professionals.