Reforming the Portuguese health services system: key human resources for health issues

In Portugal, for the last thirty years, there have been major developments in the human resources for health (HRH) situation, which are described as part of three waves of reforms. Portugal remains without a formal explicit and comprehensive HRH medium to long-term strategy. Consequently serious problems of scarcity, geographical misdistribution, and imbalances between levels of healthcare provision as well as in the ratios between professional groups and specialties still exist. Professional councils however have recognized the need for performance management and life-long recertification and have acknowledged the importance of an adequate skills mix and of complementarities through team work in the health sector. Professional associations have greatly contributed to the changes observed through a process of non-formal strategizing.     

社区卫生服务机构护士离岗意愿调查

目的 探讨社区卫生服务机构护士稳定情况,分析其影响因素,以促进社区护理队伍的稳定.方法 采用自制问卷对180名不同性质社区卫生服务中心(站)的社区护理人员进行问卷调查.结果 政府公办社区卫生服务机构有58.14%护士存在调离社区护理岗位的意愿,股份制机构有46.67%的护士存在调离意愿,私营机构有83.67%的护士存在调离意愿;不同性质社区卫生服务机构护士离岗意愿比较,差异有统计学意义(P＜0.01).结论 私营社区卫生服务机构护士的离岗意愿最高,政府公办的次之,股份制最低.     

社区卫生服务机构护士离岗意愿调查

目的探讨社区卫生服务机构护士稳定情况,分析其影响因素,以促进社区护理队伍的稳定。方法采用自制问卷对180名不同性质社区卫生服务中心（站）的社区护理人员进行问卷调查。结果政府公办社区卫生服务机构有58．14％护士存在调离社区护理岗位的意愿,股份制机构有46．67％的护士存在调离意愿,私营机构有83．67％的护士存在调离意愿;不同性质社区卫生服务机构护士离岗意愿比较,差异有统计学意义（P〈0．01）。结论私营社区卫生服务机构护士的离岗意愿最高,政府公办的次之,股份制最低。     

Building a seamless system of hospital-home health services

Robert Wood Johnson University Hospital is committed to expanding the continuum of care. To this end, 2 task forces were developed simultaneously. One was created to streamline the discharge transition planning process and produce a more efficient and effective system. The other focused specifically on the coronary artery bypass graft population, with the objective of reducing length of stay without compromising quality of care. This article describes the process from the perspective of the Home Care Department's involvement. Computerization, standardization of physician orders and nursing care plans, and testing patients' knowledge regarding nutrition and medications after discharge from the hospital are described in detail. Including home care in the planning process is the key to achieving a seamless continuum of care.     

Integrating emergency services in an urban health system

When planning for growth and management efficiency across urban health systems, economic and market factors present significant service line challenges and opportunities. This article describes the evolutionary integration of emergency services in St John Health System, a large, religious-sponsored health care system located in Detroit, Michigan. Critical business elements, including the System's vision, mission, and economic context, are defined as the framework for site-specific and System-wide planning. The impact of managed care and market changes prompted St John's clinicians and executives to explore how integrating emergency services could create a competitive market advantage.     

Maternal and infant health services and the public health clinic

The public health clinic under the jurisdiction of prefectural government should continue to play a major role in maternal-child health services. Ministry of Health's revision plan for Maternal-child Health Law, according to which maternal-child health services are to be transferred totally to municipal (city-town-village) government, is strongly opposed by public health nurses and others. The plan goes against the current movement and effort to revitalize public health clinics, where more 50% of services rendered are maternal-child health related. Secondly, municipal health centers would have much more difficulty providing quality services than prefectural public health clinics which receive annual federal aid for their operation. Federal funding for maternal-child health care, regardless of jurisdictions, is currently 1/3 of standard unit cost. Extreme financial strain on municipal governments would result in regional differences in the quality of services and/or eventual financial burden on the patients. While the national government is trying to emphasize administrative aspects of the public health clinic, it is ordinary citizens' day to day health problems that people expect the clinic to deal with, individually, via check-ups, health counseling, home visits, public health education and telephone health hot line.     

The health status of Portuguese healthcare professionals

Several studies have shown that healthcare professionals are at greater risk than the rest of the population of having certain health problems due to the specificity of their workplace and the physical and psychological demands of their work. Additionally, healthcare professionals seem to behave differently when seeking health care. Several studies also indicate that the health of healthcare professionals has an impact on the performance of services and on the health of the population. The present paper analyzes morbidity patterns, health behaviors and lifestyles, self-perceived health status and health service utilization among healthcare professionals, by using the Portuguese 1999 National Health Survey. Results differ from those found in international studies. Portuguese healthcare professionals did not suffer more from some health problems than non-healthcare professionals. Healthcare professionals tended to assess their health as good and better as that of other workers. They also reported healthier behaviors (smoked less, drank less and practiced exercise more often) and missed fewer workdays due to sickness. The percentage of healthcare professionals suffering from back pain was lower than the percentage of other workers but they started to complain earlier.