A team approach to OR environmental issues

At Munroe Regional Medical Center in Ocala, FL, an effective partnership between Materials Management and the Operating Room was begun by building consensus around a shared concern--minimizing the Operating Room's impact on the environment. To accurately evaluate cost-in-use issues, Materials Management and the OR needed a better understanding of each other's processes, procedures and decision-making criteria. Materials Management observed surgical procedures to understand product requirements, and OR personnel were given financial information on such matters as group purchasing and disposal costs. After considering all the data, the MM/OR team decided to continue using single-use polypropylene gowns rather than switch to reusable gowns. Success in this endeavor led the team to institute a disposable wrap recycling program. Lasting benefits of the collaboration include higher cost consciousness among clinicians, open communications, greater supplier accountability for cradle-to-grave cost estimates and team building.     

Farming from a new perspective: remote sensing comes down to earth

Farmers strive to increase the yield of their fields by adding nutrients and water to the land, and using pesticides to control insects and disease. In addition to bountiful harvests, the results of their endeavors may include elevated amounts of fertilizers in surface waters and aquifers and potential risk to themselves and their neighbors from exposure to pesticides. Precision agriculture is the use of modern information technologies such as geographic information systems, the global positioning system, and remote sensing from the air to reduce the environmental effects of these chemicals while enhancing the productivity of farming. By combining crop yield maps with soil survey maps and remote sensing output, farmers can identify areas that need more or less fertilizer, water, or pesticide.     

'Storytelling' by staff,patients brings issues to life,aids change

Storytelling captures group's interest and personalizes key issues. Organizations such as the National Institutes of Health and the Institute for Healthcare Improvement have gotten on the storytelling bandwagon. Technique has a virtually unlimited range of potential applications.     

Teamwork brings TQM to health care. Lessons from three years of team activity

Looks at the Swedish American Hospital institutions in Rockford, Illinois, USA which serves 700,000 people. The system incorporates four clinics, three smaller hospitals and 230 physicians over a metropolitan area. Observes how the Juran influence has improved the process and discusses triumphs and failures of the system.     

Specialty hospitals: the economics and policy issues they pose

Specialty hospitals are not a new phenomenon. From psychiatric and tuberculosis hospitals to children's and eye hospitals, they have long existed. The current interest lies in the development of single specialty hospitals for certain conditions or illness such as cardiology or orthopedics for which such hospitals were previously uncommon or non-existent. We include physician-owned surgical hospitals in our definition of single specialty hospitals. Some have claimed that these specialty hospitals (hereafter SSH) are an efficient way of producing services by concentrating them in one institution. They argue that SSHs avoid inefficiencies of scheduling and use of facilities not expressly designed for the illness or condition. Critics contend that doctors are simply trying to get the general hospital's profits and the ultimate impact will be a financial weakening of the general hospital. They argue that the cross-subsidy from these procedures and services are necessary to give general hospitals the ability to provide services to the uninsured and the poor. This debate led to a 30-month moratorium on new specialty hospitals which was lifted in August 2006. General acute care hospitals have responded by denying privileges to physicians who own or participate in competing SSHs. The appropriateness of such economic credentialing will be investigated. Further, we shall examine issues associated with Medicare pricing structures that encourage the development of SSHs as well as self-referral rules for physicians involved with SSHs. The real issue which has not been addressed is whether specialty hospitals create more value for the patient than the traditional acute care hospitals.     

Reflexive journaling on emotional research topics: ethical issues for team researchers

Traditional epistemological concerns in qualitative research focus on the effects of researchers' values and emotions on choices of research topics, power relations with research participants, and the influence of researcher standpoints on data collection and analysis. However, the research process also affects the researchers' values, emotions, and standpoints. Drawing on reflexive journal entries of assistant researchers involved in emotionally demanding team research, this article explores issues of emotional fallout for research team members, the implications of hierarchical power imbalances on research teams, and the importance of providing ethical opportunities for reflexive writing about the challenges of doing emotional research. Such reflexive approaches ensure the emotional safety of research team members and foster opportunities for emancipatory consciousness among research team members.     

Group work by the multiprofessional team in diabetes mellitus: practical issues

This single case study aims to reflect on group work in diabetes mellitus, carried out by a multiprofessional team in the education program implemented by a Preventive Medicine Service--SEMPRE. Data were collected from SEMPRE's internal documentation and through direct and participant observation by the researcher during the activities were adults and children with diabetes. These reflections occur in line with the initial formation of a group,: referral, selection and grouping. This way of working allowed for greater efficiency and lower cost-effectiveness in the education programs, requiring investments in continuous education for the multiprofessional team. Thus, there is a need to unchain a process of internal cooperation. Moreover, each health team member's knowledge needs to be made available.     

''I found myself to be a down to earth Dutch girl'': a qualitative study into learning outcomes from international traineeships

OBJECTIVE: To explore learning outcomes from international traineeships for undergraduate medical students. METHODS: In-depth interviews were conducted with 24 undergraduate medical students at Maastricht University Medical School, The Netherlands. The 24 subjects were selected by purposeful sampling. RESULTS: Students reported meaningful learning outcomes in 6 domains: medical knowledge; skills; international health care organisation; international medical education; society and culture, and personal growth. DISCUSSION: International traineeships appear to provide good opportunities for students to meet the requirements of globalisation as well as some of the generic objectives of undergraduate medical education. The tentative findings of this study need to be confirmed by further studies.