Concepts of health and well-being in managers: An organizational study

Global changes and new managerial challenges require new concepts of health and well-being in organizational contexts. In the South African context, health and well-being of managers have gained relevance in organizations and in management sciences. International organizations, in particular, attempt to address the increasing demand for health care and the delivery of health services to their managers. Careful and appropriate health management requires research to evaluate context-specific health concepts and strategies. The purpose and aim of this article is to assess managerial concepts on health and well-being that could be used by the organization to contribute to managerial well-being by implementing health promotion according to managerial needs. At the same time, this article contributes to salutogenetic health research that is very rare with regard to the South African organizational management research.This study is a multi-method research study conducted in a selected international organization in South Africa. However, in this article, selected qualitative findings will only be presented.This organizational study presents selected research findings on health concepts and strategies employed by managers. Findings demonstrate that the managerial concepts of health and strategies mainly refer to not only physical but also to mental and spiritual aspects, with a priority on physical health and well-being.The findings presented are based on qualitative research methods and their research criteria.This assessment serves as a foundation for new approaches to health management within the international work context in South Africa. It also contributes to a paradigm shift from pathogenetic to salutogenetic concepts of health and well-being within the South African organizational work context.The article produces new insights into the qualitative health concepts of South African managers and expatriates and contributes to promoting salutogenesis in organization within South Africa.     

Digital health: Cybersecurity is a value creation lever,not only a source of expenditure

Digital technologies have become an essential lever for developing patient-centered services and outcomes while ensuring financial sustainability in healthcare organizations and systems. They contribute to provide high quality, coordinated, and continuing care; to improve practices and support strategies for the management and monitoring of the population health; and to build collective responsibility for healthcare stakeholders to contain costs. However, digital technologies involve significant changes, sometimes breaking with what constitutes known commodities in healthcare organizations and systems (e.g., data governance, inter-operability, security and safety, literacy and training). The recent cyberattacks that have affected and disrupted many healthcare organizations and systems around the world are one of the illustrations. These events show that the issue of cybersecurity should not continue to be considered as a mere source of expenditure but as a source of value creation.     

Knowledge,strategies and ideologies of nursing: a reflection based on the Lopes' study

This paper makes a reflection on the knowledge and ideologies present in the nursing practice within a hospital context, based on theoretical references used by the sociologist Noemia da Glória Mendes Lopes in her MS dissertation in Lisbon, Portugal, in 1994. In this dissertation she analyzes the work of nurses within hospital contexts. The author observed that within the professional context of nursing there are many social practices of work indicating different strategies of valuing and revaluating the profession. It was concluded from this reflection that there are better possibilities of performing such strategies in specialized services than in medical clinic services.     

Creating the future. Nurses can shape their profession by getting involved in healthcare reform

To remain relevant in a reformed healthcare system, nurses will have to redefine and remake themselves. Three aspects of the new healthcare age--megahospitals, managed care, and redefined professional roles--will have a significant impact on healthcare professions, including nursing. Across the United States hospitals are merging to form sophisticated networks that provide a continuum of care. Under this delivery model, nurses will play a variety of new roles and work collaboratively with the entire spectrum of health social service professionals. A related development--the growth of managed care--is an increasingly attractive option among large employers. It will also accelerate changes in the way healthcare professionals work. Managed care will force physicians to enter into appropriate group affiliations and hospitals to reconfigure themselves to meet the needs of a dynamic system that no longer requires yesterday's beds or management structures. The future will force healthcare professionals to go through regular, radical changes in their job requirements. But it will also allow nurses and others to emerge from their task-oriented past and take on work that requires them to think, judge, and intervene.     

Four strategies for recruitment and retention.

The combined pressures of a shrinking work force, an aging population, changing social attitudes toward work, financial constraints, and public perception of healthcare have contributed to a growing personnel problem for healthcare organizations across the country. In fact, decreasing job satisfaction among healthcare employees has them headed for the doors in search of nonhospital jobs that can offer flexible hours, more opportunities, equal or better pay, and less stress. Without sufficient numbers of personnel, healthcare organizations will not be able to meet the needs of their communities. And the need for healthcare services will continue to grow as the Baby Boomers age.     

Five years of the National Policy of Humanization: the trajectory of a public policy

This article presents the context of the emergence and implementation of the National Policy of Humanization (NPH), which was devised as a public policy to address and overcome the challenges perceived by Brazilian society regarding the quality and dignity of healthcare. The aims include redesigning and joint initiatives for the humanization of care, and providing solutions for problems in the field of management and organization of the health workforce. Highlighting it as a public policy, the authors analyze the main focus and theoretical and methodological approaches to cope with problems in management and practice of healthcare, signaling the need to combine strategies in both macro and micro policy areas. The analysis focuses on changes in the composition and strategies of action, which include social mobilization, support to management systems, services and health teams and the development of training processes for institutional stakeholders. The article presents results obtained in the first five years, as well as its limitations and prospects, especially the challenge facing NPH to be seen as a public policy, which cannot be achieved without the mobilization of social forces beyond the State.     

HMOS' continuum of care. How HMOs target their services to meet the needs of the elderly

As healthcare organizations begin to expand their services to serve the elderly, they can learn from the experience of managed care providers. Kaiser Permanente in San Diego, a health maintenance organization (HMO) integrates healthcare providers with more traditional hospital services such as discharge planning and placement coordination, as well as social services, care management, and rehabilitation. Having all these services in the same office facilitates good patient care and planning. When a patient goes into hospice, home care, or a skilled nursing facility, one of four physicians takes on sole responsibility for his or her treatment and continuity of care. Group Health Cooperative of Puget Sound, Seattle, is a consumer-governed HMO. Group Health makes decisions based on data about enrollees plus input from medical staff and senior groups. It emphasizes putting the right services with the right consumer using subgroupings based on functional status: healthy, moderately frail, and frail. Seniors Plus, a social HMO in Minneapolis, integrates acute and long-term care. Providers determine who needs functional assessment and care management by looking first at the diagnosis, then the severity of impairment and comorbidity, other medical problems such as depression and falling that indicate a need, and finally limitations in function and ability to perform activities of daily living.     

UNDERTAKING RESEARCH FOR THE BENEFIT OF THE RURAL COMMUNITY

ABSTRACT: This paper discusses the importance of disseminating clinical research findings to improve nursing practice and, ultimately, the health of rural Australia. It is argued that nursing in all settings must be practised within the context of changing healthcare trends. Currently, these changes include the restructuring of health services toward a greater emphasis on community-based services, a redirection of the focus of care toward population health rather than hospital-based service provision, multidisciplinary clinical decision-making with the community as partner, and the need for all health professionals to maintain fiscal and clinical accountability. To chart the process and outcomes of care in these changing circumstances requires ongoing, systematic research. The global movement toward evidence-based healthcare practice is thus timely and necessary. In order to provide a foundation for evidence-based practice that will demonstrate quality, efficiency, effectiveness and community acceptability, employers must address both infrastructure and educational needs. Educators must be responsive to changes in the organisation and funding of care. Also both groups must work collaboratively toward ensuring dissemination of research information that will make a difference to patient and community outcomes. The key to success is ongoing communication between employers, educators, practitioners in the field, community members and professional organisations so that research findings can be analysed in simple language that increases utility and that provides a forum for valuing information from all sources.     

AIDS-Prävention – ein Erfolgsmodell in der Krise

The rising number of new HIV infections in Germany, particularly among men who have sex with men, raises the question whether the previously successful prevention strategy should be revised. This strategy has been based on a New Public Health approach which arose from the specific historical context in Europe at the start of the epidemic. The hallmarks of this approach are: the active involvement of the target groups; the central role of non-governmental organizations; the combination of population level and targeted, context specific interventions; and an emphasis on social integration and voluntary participation in the work with target group members. Current challenges include: changes in risk perception (at least in part due to the availability of more effective treatments); a diversification of prevention behavioral strategies among target group members; the formation of new sexual subcultures and target groups; as well as changes in hard-to-reach populations such as immigrants and people of lower socioeconomic status. In order to meet these challenges the following measures are necessary: an increased investment in prevention research (with a particular focus on interventions specific to social contexts in which risk behavior is increasing); further development of the institutional infrastructure for prevention, including the full implementation of UNAIDS guidelines for national prevention strategies; and improving the prevention work of local AIDS service organizations and public health authorities through an increase in funding and the implementation of quality assurance measures based on participatory action research.     

Leadership and the UK health service

This paper explores future leadership requirements for health services in the context of relevant leadership theory and the changing environment for health services in the UK. The output of leadership research is both prolific and confusing and its applicability to health services management uncertain especially in the context of constraints on the strategic managerial behaviour and choices of public service managers. The introduction of general management to the UK NHS in the 1980s, followed by an internal market for health care in 1990 should have provided the opportunity for managers to work differently and to create personal space for leadership. However, it is not known whether sustainable , new ways of leadership working have emerged although it is reasonable to hypothesis from studies elsewhere that a number of contextual and behavioural leadership models are likely to be found in the NHS. Although management researchers have explored networking and referred to the impact of the external environment of leadership, insufficient importance has been attached to-date to the impact of future trends in health services on the leadership of change in the health sector. The paper argues that in future health services leadership will require much more than traditional networking with other organizations and groups and will need to focus on developing and securing external agreement to an agenda for positive change turning the apparent constraints of the external environment, determined primarily by government policies,into opportunities. In other words, the demands of external or contextual leadership will increase forcing a stronger focus on having to achieve change through others.     

A flexible nursing workforce: realities and fallouts

While policy-makers are increasingly concerned about a looming nursing shortage, almost half of Canada's nursing workforce is currently employed on a part-time or casual basis. Why are so many nurses not working full-time and providing the nursing care that would help to alleviate such shortages in our healthcare organizations? Do nurses want to work part-time, or are they driven into this by labour market forces, life demands, poor working conditions and policy decisions external to them? The answers to these questions are critical to ensure that care will be there for all of us. This article presents a brief analysis of flexible employment arrangements in nursing, particularly part-time and casual work, and the impact on nurses, patients and the healthcare system as a whole. Given the sharp increases in these work arrangements in Canada during the last decade, the limited discussion of these trends in the literature is both surprising and troublesome.     

Endomarketing: Essay on possibilities of innovation in nursing management

This article is aimed at presenting endomarketing as a tool for nurses in the management process, taking into account the current context of changes in the healthcare sector, which also requires the development of skills that are directly related to the introduction of new technologies and ways of work organization. Our reflection leaves some important points to be analyzed by nurses and educators in the search for better ways and alternatives for educating nurses who will have greater professional satisfaction and competence to manage the healthcare services. The big challenge of endomarketing is, therefore, to combine the aims and interests of the internal public with the needs and expectations of the external public in the organization.     

National outcomes management survey: summary report

Spurred by national trends towards accountability and outcomes management, behavioral healthcare organizations are increasingly focused on efforts to develop and implement outcomes research strategies. CentraLink, in cooperation with the Institute for Behavioral Healthcare, developed a survey designed to reflect and summarize current outcomes efforts in early 1994. This column provides a brief summary of several salient features reported by organizations responding to that survey.     

The fiscal crisis in the health sector: Patterns of cutback management across Europe

PurposeThe article investigates trends in health sector cutback management strategies occurred during the ongoing financial and fiscal crisis across Europe.SettingA European-wide survey to top public healthcare managers was conducted in ten different countries to understand their perception about public sector policy reactions to the financial and economic crisis; answers from 760 respondents from the healthcare sector (30.7% response rate) were analyzed.MethodA multinomial logistic regression was used to assess the characteristics of respondents, countries’ institutional healthcare models and the trend in public health resources availability during the crisis associated to the decision to introduce unselective cuts, targeted cuts or efficiency savings measures.ResultsDifferentiated responses to the fiscal crisis that buffeted public finances were reported both across and within countries. Organizational position of respondents is significant in explaining the perceived cutback management approach introduced, where decentralized positions detect a higher use of linear cuts compared to their colleagues working in central level organizations. Compared to Bismark-like systems Beveridge-like ones favour the introduction of targeted cuts. Postponing the implementation of new programmes and containing expenses through instruments like pay freezes are some of the most popular responses adopted, while outright staff layoffs or reduction of frontline services have been more selectively employed.ConclusionTo cope with the effects of the fiscal crisis healthcare systems are undergoing important changes, possibly also affecting the scope of universal coverage.     

Medication errors and risk management

Healthcare risks in general, and those related to medication errors in particular, constitute a serious problem with consequent human, medical, and economic repercussions which healthcare authorities are recognizing and addressing as priority matters in some countries. However, though the magnitude of the problem is similar in Spain, this country has yet to become fully aware of the transcendence of the situation. Risk management activities in healthcare centers are presently evolving as risk managers adopt preventive and proactive approaches requiring the collaboration of other healthcare professionals in developing risk reduction programs, including those focused on medication error prevention. This article briefly describes the principal bases for safety improvement strategies, and outlines a risk management program for medication error prevention in hospitals. In short, it is assumed that risk managers form part of a team whose job it is to analyze incidents when they occur, use this information to establish actions for improving healthcare services through risk reduction, and ensure that the principles of risk management form an integral part in the activities and the culture of organizations. The final result of risk management is the establishment and maintenance of significant system changes which enhance the quality of healthcare services and achieve greater patient safety.     

Management matters: technology succeeds when management innovates

It is widely believed that better technology means better business: now that consumers and patients have direct access to computers and information services, the cost of care should decrease and services improve. Yet even with the advent of computer technology and the phenomenal growth of the Internet, costs have increased and quality problems have persisted. Far more important than the technology, then, is how business is conducted and systems are organized. Despite overwhelming evidence that computer services can significantly reduce the costs of care, healthcare organizations have not adopted the changes, or have tried and failed. This article explores what it will take to succeed. We propose a list of necessary nontechnical changes. Patient expectations will change the nature of care; clinicians' roles and training, the gatekeeper profession, healthcare financing and bundling of services, and capital costs will all change. In the end, management innovations make the difference between the success and failure of new technology. Technology is important, but it is not enough. Without new practices, we can buy the technology but will fail to effectively use it. Unless management modifies the very nature of its business, technology's promise to the healthcare industry will go unfulfilled.     

Mental healthcare: expand with caution. There is more involved than financial incentives

Increased needs, insurance coverage, and physical expansion are evidence of mental healthcare's growth. Greater societal acceptance, the demand for more local care with deinstitutionalization, and liberal reimbursement have expanded mental health services. However, reduced federal funding and competition demand specialization in such areas as geriatric services. Ambulatory services make mental healthcare more affordable and accessible. Providers must target populations who use such outpatient care and study local trends before planning these programs. Inpatient mental health services continue to expand, although at a slower rate. Thus organizations and professionals have begun selective contracting, and capitation reimbursement based on case management is developing. Providers considering expansion or initiation of mental health services confront competitive marketing and must recognize trends in outpatient, chronically ill patient, and after-care services. Strategic planning is essential to uncover opportunities and potential risks. Other issues to consider include the psychiatrist shortage, uncertain payment systems, and a possible reversal of growing mental health services and declining acute care needs.     

Social context for workplace health promotion: feasibility considerations in Costa Rica,Finland, Germany,Spain and Sweden

We constructed a simple, flexible procedure that facilitates the pre-assessment of feasibility of workplace health promotion (WHP) programmes. It evaluates cancer hazards, workers' need for hazard reduction, acceptability of WHP, and social context. It was tested and applied in 16 workplace communities and among 1085 employees in industry, construction, transport, services, teaching and municipal works in Costa Rica, Finland, Germany, Spain and Sweden. Social context is inseparable from WHP. It covers workers' organizations and representatives, management, safety committees, occupational health services, health and safety enforcement agencies, general health services, non-government organizations, insurance systems, academic and other institutions, regulatory stipulations pertaining WHP, and material resources. Priorities, risk definitions, attitudes, hazard profiles, motivations and assessment methods were highly contextual. Management preferred passive interventions, helping cover expert costs, participating in planning and granting time. Trade unions, workers' representatives, safety committees and occupational health services appeared to be important operational partners. Occupational health services may however be loaded with curative and screening functions or be non-existent. We advocate participatory, multifaceted WHP based on the needs and empowerment of the workers themselves, integrating occupational and lifestyle hazards. Workforce in irregular and shift work, in agriculture, in small enterprises, in the informal sector, and immigrant, seasonal and temporary workers represent groups in need of particular strategies such as community health promotion. In a more general framework, social context itself may become a target for intervention.     

Strategic performance management: development of a performance measurement system at the Mayo Clinic

Managing and measuring performance become exceedingly complex as healthcare institutions evolve into integrated health systems comprised of hospitals, outpatient clinics and surgery centers, nursing homes, and home health services. Leaders of integrated health systems need to develop a methodology and system that align organizational strategies with performance measurement and management. To meet this end, multiple healthcare organizations embrace the performance-indicators reporting system known as a "balanced scorecard" or a "dashboard report." This discrete set of macrolevel indicators gives senior management a fast but comprehensive glimpse of the organization's performance in meeting its quality, operational, and financial goals. The leadership of outpatient operations for Mayo Clinic in Rochester, Minnesota built on this concept by creating a performance management and measurement system that monitors and reports how well the organization achieves its performance goals. Internal stakeholders identified metrics to measure performance in each key category. Through these metrics, the organization links Mayo Clinic's vision, primary value, core principles, and day-to-day operations by monitoring key performance indicators on a weekly, monthly, or quarterly basis.     

Taking a new approach to reduce the incidence of physician disruptive behaviors

Disruptive behaviors continue to play a disturbing role in today’s healthcare environment, negatively affecting care relationships that can adversely impact outcomes of patient care. Many organizations have implemented a number of different strategies in an effort to address this important issue with varying degrees of success. New complexities and changing roles, responsibilities and accountabilities for the delivery of appropriate, high-value, high-quality, safe, satisfying care have added increasing pressures on healthcare organizations to better integrate and coordinate healthcare delivery across the entire spectrum of care. Physicians play a crucial role in this process. When disruptive behaviors occur, rather than taking the traditional more remedial punitive approach to behavioral management, organizations would do better to try to focus on strategies that address physician and staff needs and provide appropriate supportive services to help them better adjust to stress and pressures of today’s healthcare environment. Increasing levels of stress and burnout are taking their toll on physician attitudes and behaviors resulting in increasing levels of disillusionment, dissatisfaction and frustration affecting physician well-being and performance. Physicians often won’t act on their own and we need to look to the organizations they are affiliated with to take the initiative by providing appropriate administrative, clinical and emotional support services before the occurrence of an unwanted event. Allowing physicians’ input, listening to their concerns and providing needed support will enhance physician satisfaction, engagement, compliant attitudes and behaviors that lead to less disruption and better patient care.