Facilities management contracting: the key to effective change management

Facilities Management Contracting is a catalyst for developing high performance individuals and teams to deliver value for money in today's demanding funding environment. It is a key to unlocking individuals' creativity, and learning, through effective change management strategies, and to developing organisational processes and structures to promote this. Sarah Meads, General Manager of Serco Health Services, explores how health providers could make more effective use of Facilities Management Contracting to release the potential that already exists within their organisations by thinking of Facilities Management as a change management tool. Serco Health Services is the division of Serco Group NZ Limited responsible for assisting healthcare providers to review and manage a wide range of non-core support services.     

Perspectives on ethics in child and youth care

The request for an undergraduate course in ethics was the context for a research study in both the teaching and researching of ethics in the field of child and youth care. An action research approach allowed class participants to reflect on and give meaning to ethical dilemmas in child and youth care practice. Students concluded that child and youth care workers are often ill-prepared to deal with ethical dilemmas and described awareness and fear as playing major roles in ethical practice.     

Pain and the ethics of pain management

In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern.     

The integrated supplier: key to cost management and multi-franchise capitation contracting

Capitation...most healthcare providers do not work under it, comprehend it, or even want it, yet supply capitation contracting seminars are popping up everywhere creating the feeling that the bandwagon is leaving, and it might be time to get on board. Not true. Supply capitation is not for all organizations. Capitation contracting is not easy and there are not many successful models to help the uninitiated. If a panacea is sought for reducing supply costs, capitation is only one component of a systematic strategy to reduce materiel costs. This article suggests a direction using the Group Health Materiel Management (Group Health Cooperative of Puget Sound, WA) experience as a point of reference. It advocates a systematic approach that focuses on expense reduction in: cost of goods, holding cost of inventory, labor cost associated with all materiel processes, distribution cost (transportation and par stock pick, pack, and replenishment), product utilization, variation in product standards, and waste stream byproducts. At Group Health (GH) these issues are primarily addressed through the use of: information systems, supplier certification/selection processes, group purchasing compliance, supply channel management, supply capitation contracting programs, standardization, and utilization management. Because of managed care organizational structure, Group Health Cooperative supply capitation contracting, as performed at GH, is discussed not as a quick fix solution but in the spirit of sharing our experience with others who may be considering it as a cost savings tactic in the context of a broad-based materiel management strategy. This article highlights the experiences of GH beginning with materiel management's business process assumptions toward multiple-franchise supply capitation.     

The ethics of Pharmaceutical benefit management

Efforts to limit pharmacy costs raise both ethical and economic considerations. Six values should inform pharmacy benefit management: (1) accepting resource constraints; (2) helping the sick; (3) protecting the worst off; (4) respecting autonomy; (5) sustaining trust; and (6) promoting inclusive decision making. Direct controls, such as formularies, step therapy, and prior authorization, can focus limited resources on the sick and worst off. However, direct controls limit autonomy and are administratively burdensome. Indirect controls, such as physician capitation, tiered copayments, and drug benefit caps, align physicians' and patients' interests with resource constraints, respect autonomy, and are administratively efficient. Unfortunately, they deter use based on cost, not medical need; they do not focus cuts on unnecessary or marginal drug use or focus resources on the sick. Budget caps are the least defensible, while tiered copays and physician capitation can be justified if implemented with safeguards. Formularies and step therapy are ethically justifiable if they can be efficiently instituted.     

我国食品卫生管理体制改革展望

我国是一个单一制国家,建国以来党和政府十分关心人民群众的食品安全与卫生,1953年我国成立了与行政区划相一致的各级卫生防疫站,承担包括食品卫生技术指导与宣传职责在内的公共卫生技术服务工作。针对我国由于食品污染引发急、慢性食物中毒的问题,由卫生部门牵头,先后制定了各     

试论非食用物质的危害与管理

本文通过阐述近年来媒体报道的10类非食用物质,剖析其危害及监管法律法规,并提出一些建议。