Professionalism among allied health staff. The PLEASE CARE program

Professionalism affects the quality of medical care in terms of clinical outcomes, safety, and service. Although often talked about by physicians, professionalism is important for all who are engaged in clinical care. In our continuous effort to improve quality at Mayo Clinic, we hypothesized that patient satisfaction was affected by the professionalism of the allied health staff. Our aim was to improve patient satisfaction by training employees on behaviors and attitudes that could significantly affect patient satisfaction. More than 4,000 allied health staff have gone through the training program called "PLEASE CARE." More than 2,000 patients received point-of-care surveys before and after implementation of the program. We found patient satisfaction with the allied health staff increased from 71% to 77% after the training. We also saw improvement in each of the individual PLEASE CARE attributes. This demonstrates that enhancement of professionalism among allied health staff can have a positive effect on the experience of patients.     

The potential for using cognitive styles as selection predictors for allied health education administration programs

Institutions of higher education appear to be using inappropriate measures to select students who aspire to become allied health education administrators. Therefore, new selection predictors need to be developed and validated. This article reports the results of a survey investigation conducted to determine the feasibility of using two cognitive styles, dogmatism and integrative complexity, as selection predictors for allied health graduate leadership programs. The findings indicate that current allied health education administrators are similar in cognitive style, low in dogmatism and high in integrative complexity. The findings support the premise that cognitive styles are related to both occupational choice and performance and, thus, provide a potentially powerful basis for selecting appropriate individuals for allied health graduate leadership programs.     

Physician well-being and professionalism

Physician professionalism is influenced by both environmental and personal factors, one of which is physician well-being. Yet, a variety of stressors inherent in medical training and practice can erode a physician's sense of well-being and contribute to distress. This article reviews the epidemiology of physician distress; describes what is known about the relationships between distress, well-being, and professionalism; and discusses personal and environmental factors that contribute to professionalism among physicians.     

Perceived prestige and health careers recruitment

Perceived occupational prestige is an important factor in career choice. The purpose of this study was to obtain prestige ratings of 13 allied health occupations and 13 general occupations for high school students, community college students (nonhealth majors), and community college health occupations students. The obtained ratings were compared with ratings of a combined group of health care providers. There was little agreement among the groups as to level of prestige. The high school rankings were the most disparate. Career exploration and outreach programs as part of recruitment efforts by health care institutions are suggested.     

Space allocation decisions in schools of allied health

Growth is continuing in schools of allied health in terms of faculty, enrollments, the use of university-based clinics and in the volume of training facilities required for allied health education. At the same time, budgets for future expansion of facilities are likely to become more stringent. Thus, the efficient allocation of physical space within schools of allied health is extremely important and it will become more important in future years. This paper examines procedures for evaluating space needs in allied health schools. A number of possible approaches, and their strengths and weaknesses, are explored. Influences of the physical environment--of which space is a primary component--on behavior is considered in the context of allied health education and their implications for space allocation are explored. The likely effects of Occupational Safety and Health Administration (OSHA) regulations on space utilization are also examined. Throughout the analysis recommendations are made for the safe and effective use of the available physical space within which allied health education occurs.     

Duties, fears and physicians

This article deals with the physician's fear of contagion using AIDS as a paradigm. It deals with this in four ways: it examines the concepts of duty, fear and courage in their medical setting; it deals with the historical aspects of the problem; it analyzes the role of social contract and professionalism; and it develops a viewpoint of the physician's obligation based on these considerations and predicated on a view of professionalism and social contract.     

Dentistry and medical dominance

In this study, I explore the relationship between medicine and dentistry in Ontario between 1868 and 1918. Examination of the rise of dentistry and medical-dental relations reveals that medicine never came to dominate dentistry to the extent it did other health care occupations. The combination of four factors enabled dentistry to avoid outright medical dominance in Ontario. First, dentistry organized and professionalized at approximately the same time as did medicine in Ontario. Second, dentistry's jurisdiction remained somewhat separate from medicine's. Third, unlike other health care occupations, the dental profession never challenged medicine's claims to knowledge or expertise. Fourth, dental and medical leaders shared gender and class backgrounds, identities, and goals that discouraged conflict between them. The importance of these four factors and their implications for future research into inter-professional relations and medical dominance are discussed.     

A review of recruitment and retention programs for minority and disadvantaged students in health professions education

Since the late 1960s, allied health educators have been providing special activities designed to recruit and graduate minority and disadvantaged students. Summer enrichment, prematriculation, and a variety of other student support programs have been used to benefit students, institutions, and society. Colleges of allied health are becoming increasingly concerned with recruiting and retaining all students. Fortunately, lessons learned from these special programs can be used to ensure the enrollment of capable learners and the graduation of competent allied health professionals. To accomplish this, student recruitment and retention must be viewed as a process of interrelated activities. Faculty, students, and administrators must be involved in planning, implementing, and evaluating programs to ensure that the components of the recruitment and retention process are meeting the needs of the learner and the institution. This article provides a historical perspective of these activities and suggests means by which process components could be made more effective.     

Tenure and the allied health professions: issues and alternatives

This article traces the development of tenure from its origins to modern times. External and internal pressures and constraints which have led to a debate on the nature and need for the existence of tenure are described. The traditional and alternative tenure models are set forth. The impact of the tenure process upon the allied health professions is discussed, and the authors recommend that the allied health professions should strive for professional parity by adopting the traditional criteria for tenure.     

Computer use in allied health programs

This article presents a preliminary assessment of computer use in allied health programs. The findings of a survey among 60 allied health programs indicate that computer use in the classroom, in clinical education, and in simulation has increased. In preprofessional education, computers are used by less than 50% of the allied health programs. However, computers are used more in the professional phase for patient management, clinical simulations using branching and logic methods, physiological simulations, and therapeutic planning and management. Students in these programs are required to take three to six semester hours of computer literacy classes. In the classroom, computer-assisted instruction is used to provide remediation, reinforcement, enrichment, and test-taking drills in clinical and didactic learning. Students use microcomputers to gain application experience in health statistics, data bases, abstracting, and diagnosis-related group classifiers. Although progress has been made in computer use, greater efforts must be expended to ensure greater use of computer technology in the next decade in allied health disciplines. Recommendations for increased use of computer technology in allied health programs are provided.     

A historical perspective on professional values

This article demonstrates the use of historical research to improve present allied health practice. The relationship between social values and the emergence of occupational therapy during the progressive era (1890-1920) is explored. This energetic period of history provided an opportunity for physicians to assume social, moral, and scientific leadership in a society that longed for expert solutions to complex social problems. At the turn of the century, occupational therapy, physical therapy, medical social work, and speech therapy all expanded the influence of the physician's expertise. Occupational therapy was originally developed to care for chronically impaired individuals. The relationship established between the physician and the therapist over 75 years ago still influences the status of both professions today.     

医保从业人员职业化的思考

由于我国医疗保险行业的人才队伍建设滞缓,开展医保工作一直受制约。本文通过参考国内外先进医院管理模式及医保从业人员职业化的发展趋势,对目前医保管理人员专业化、职业化发展的趋势,医保经办机构人员的从业背景、创建医保从业人员职业化之路、增设医保专业的技术职称提升专业化水平等方面内容来阐述,阐明建立一支专业化、职业化的人才队伍,对我国医疗保障事业具有极其重要的意义,同时,为保护民众的生命健康、构建和谐社会主义社会提供有力的支持和保障。     

A comparison of occupational stressors in selected allied health disciplines

Work-related stressors have been linked to a number of diseases, both physical and psychological. Previous studies have revealed that the stressful occupational components are particularly apparent in health care occupations. Occupational sources of stress in three allied health disciplines--nuclear medicine technology, radiologic technology, and medical technology--were studied over the last three years via responses from approximately 500 practitioners. The top five stressors in each discipline were as follows: nuclear medicine technology--equipment malfunctions, add-on examinations, uncooperative physicians, lack of staff, and uncooperative patients; radiography--disrespectful physicians, inadequate pay, unnecessary examinations, lack of staff, and lack of respect; and medical technology--equipment breakdown, poor management practices, difficult coworkers, lack of time, and exposure to human immunodeficiency virus. It is crucial for administrators and fellow health care professionals to be aware of and address those areas of job-related stress that may impact the quality of patient care and the well-being of the allied health professional.     

Multisource feedback in the assessment of physician competencies

Multisource feedback (MSF), or 360-degree employee evaluation, is a questionnaire-based assessment method in which rates are evaluated by peers, patients, and coworkers on key performance behaviors. Although widely used in industrial settings to assess performance, the method is gaining acceptance as a quality improvement method in health systems. This article describes MSF, identifies the key aspects of MSF program design, summarizes some of the salient empirical research in medicine, and discusses possible limitations for MSF as an assessment tool in health care. In industry and in health care, experience suggests that MSF is most likely to succeed and result in changes in performance when attention is paid to structural and psychometric aspects of program design and implementation. A carefully selected steering committee ensures that the behaviors examined are appropriate, the communication package is clear, and the threats posed to individuals are minimized. The instruments that are developed must be tested to ensure that they are reliable, achieve a generalizability coefficient of Ep2 = .70, have face and content validity, and examine variance in performance ratings to understand whether ratings are attributable to how the physician performs and not to factors beyond the physician's control (e.g., gender, age, or setting). Research shows that reliable data can be generated with a reasonable number of respondents, and physicians will use the feedback to contemplate and initiate changes in practice. Performance may be affected by familiarity between rater and ratee and sociodemographic and continuing medical education characteristics; however, little of the variance in performance is explained by factors outside the physician's control. MSF is not a replacement for audit when clinical outcomes need to be assessed. However, when interpersonal, communication, professionalism, or teamwork behaviors need to be assessed and guidance given, it is one of the better tools that may be adopted and implemented to provide feedback and guide performance.     

Utilization of allied health personnel in HMOs

Health Maintenance Organizations (HMOs) have become a significant component of the health care delivery system and thus provide employment opportunities for allied health professionals. This study investigated the utilization of selected allied health services and personnel in a national sample of HMO settings. Significant utilization of allied health services were reported both through provision of services in-house and through contractual arrangements. Smaller HMOs tended to use several allied health services in-house, while larger HMOs used both in-house and contractual services. Younger HMOs tended to utilize contractual arrangements while older HMOs utilized in-house services. Staff and group HMOs tended to have the highest utilization of health manpower with the larger, older HMOs employing more of those personnel.     

Student recruitment in allied health educational programs: the importance of initial source of contact

As a part of a larger study on recruitment and marketing strategies adopted by allied health programs, this article examines the effect of initial source of information about allied health career opportunities on students' decisions to select and enroll in allied health programs. Using data obtained from 1,809 students currently enrolled in six allied health disciplines, this investigation revealed that allied health students receive career information from various sources. Practicing health professionals are the most effective initial source of information for prospective allied health students. Prospective students are more inclined to enroll in allied health educational programs if they are encouraged to do so by a practitioner. Also, it was observed that 1) most students decide about their career interest at an early age; 2) their first-degree interest is not always the one they eventually pursue in college; and 3) the effect of initial source of information on enrollment decision varied by discipline. Contrary to a widely held assumption, only two groups of students (physical therapy and dental hygiene) identified high school counselors as an important source of initial information about allied health educational programs.     

Facilitating culturally integrated behaviors among allied health students

This article offers a perspective on why culturally integrated behaviors are important for allied health education and suggestions of methods to facilitate such behaviors. Literature and theory are used to support cultural integration in allied health curricula. Examples of learning experiences from students in cross-cultural environments and reflections on those experiences further elucidate facilitation methods.     

Physicians contracting with managed care, Medicare, and Medicaid

Managed care has become an ever important form of health care delivery, yet little is known about the characteristics of providers contracting with managed care organizations. Using data from a national survey of 4,729 physicians, we find that market conditions, specialty, and sociodemographics all affect a physician's decision to contract with managed care. Moreover, most of these characteristics also have similar effects on a physician's decisions to participate in Medicare and Medicaid. The latter result implies that physicians view managed care, Medicare, and Medicaid similarly when making contracting decisions, although financial incentives in these insurance programs are different.     

A study of tenure among allied health faculty.

Most allied health faculty are practitioners who hold a master's degree. Consequently, they may not be prepared to face the rigorous criteria of the tenure system. A study was conducted to identify the demographic characteristics of allied health units, their tenure policies, the criteria for tenure, and any trends in tenure. Deans and directors of 310 allied health units were surveyed and 47.0% responded. In general, allied health tenure policy is drafted by faculty, then sent to the administration for approval. The availability of alternatives to tenure, tenure fractions, and requirements for tenure vary with institutional type. Allied health units reported a tenure fraction of 35.5%, compared to 58.2% for campuses in general. Most of the survey respondents agreed that there is a trend toward increasing the rigor of tenure criteria, and that this trend will come from both within and outside of allied health. As allied health faculty become more involved with research, their tenure fraction will increase and their policies for tenure will more closely conform to those of other units within the parent institution.