Dimensions of managerial work in hospital dietetic services

The objective of this study was to identify underlying dimensions of the managerial work of hospital dietetic services professional staff. A survey instrument was developed on the basis of Mintzberg's role theory of management. Respondents were asked to rate 80 activity statements on the relative importance and time demand of each. Principal component analysis was used to determine whether items could be conceptualized meaningfully by a smaller number of components capable of accounting for interrelationships. Reliabilities and correlations were computed for the resulting managerial factor scores. Six factors were identified from the importance ratings: Upper Management, Interaction with Subordinates, Outside Activities, Quality Assurance, Communication Activities, and Personnel Activities. Similar dimensions were identified from the time-demand ratings. Findings from this analysis suggest that managers in different functional specialties and at various organizational levels tend to vary in their allocation of time and to stress different roles. As a person rises on the administrative ladder of responsibility, concentration on extramural affairs and involvement in planning are greater, and concern with specific operational problems decreases. The importance of conceptual skills was especially evident in upper administrative positions, as was the critical need for intergroup skills.     

The development of clinical psychiatric dietetic technicians

Employing dietetic technicians to complement and enhance the roles and responsibilities of clinical dietitians is not a new practice. But tailoring the training of the dietetic technician to meet the needs of a specific psychiatric institution is unique. The successful clinical psychiatric dietetic technician training program also assisted the hospital in extending the nutrition care services offered to the patients.     

Marketing the dietetics profession to consumers and stakeholders: A social and professional imperative

(Nutr Diet 2005;62:158–160) In the present paper we argue that despite the potential impact of dietetic practice on public health, the use of professional dietetic services appears to be stagnant. To redress this position, dietitians may need to increase their use of marketing activities to promote the value of the profession. We discuss the different roles of the Dietitians Association of Australia and of individual members in marketing activities, provide an overview of the key components of a marketing plan and strategy, and outline specific steps that dietitians can take to actively promote their services. We argue that promotion of the dietetic profession may ultimately contribute to better health through nutrition for the Australian population.     

Management coursework in graduate behavioral health programs

Many behavioral health professionals eventually assume managerial roles; therefore the extent to which graduate behavioral health programs adequately prepare them for these roles is of concern. To examine this issue, directors from graduate behavioral health training programs were surveyed about whether organizational behavior coursework was routinely provided to their students. Results indicated that while this coursework was provided in most social work and psychiatric nursing programs, only a minority of clinical psychology and psychiatry residency programs offered it. These findings suggest that psychiatrists and psychologists may need more preparation than their non-doctoral-level colleagues to assume administrative positions, and that health administration programs may do well to develop continuing education programs geared specifically toward these groups.     

Risk management and hospital food service: food safety quality system in healthcare

In this article we describe a project about reorganisation of dietetic and hospital food service which aims to implement a food safety quality system from the prospective of risk management approach. The main objective is to develop structural and systematic activities from the medical direction point of view on all those activities concerning with hospital food service and dietetic with the following actions: 1) epidemiologic surveillance, 2) monitoring and output control, 3) education, training and information for staff and patients. The operative context is particularly complex for many reasons: the prevalent tendency to outsourcing for food service, the involvement of many professionals and several medical and non medical units. Actually after the redefinition of the main tasks (food hygiene and dietetic are the first functions) the organizational analysis, we have already done the corrective actions finalized to the improvement of quality and it is going to be ready a list of quality indicators to evaluate and continuous monitoring efficacy on the same corrective actions.     

The paradox of the not-for-profit hospital

This quantitative research study assesses the organizational characteristics, market factors, and performance of not-for-profit hospitals in the United States. These results have managerial implications related to hospital efficiency, organizational performance, and the role of not-for-profit hospitals within local communities. The study has policy implications on access to clinical services within local communities, the availability of charity care, and the long-term viability of the not-for-profit health care industry due to potential bankruptcy and closure. This study clearly demonstrates that not-for-profit hospital managers are faced with declining profitability and are challenged to reduce hospital-operating expenses while meeting their charitable mission. Additionally, the greater size and increased clinical complexity of not-for-profit hospitals are increasing organizational overhead. In many cases, the increased clinical complexity is a commitment to the organizational mission of providing a full range of services to the community. From a policy perspective, the study suggests that not-for-profit hospitals have aging facilities and reduced cash flow due to lower profit margins. As a result, many not-for-profit hospitals face potential bankruptcy and closure. This study clearly documents a threat to the provision of charity care in local communities and the long-term viability of the not-for-profit health care industry in the United States.     

Leadership in clinical dietetics: meeting the challenge to roles in nutritional support

The success of efforts to improve nutrition training of other health professionals poses a threat to the position of clinical dietitians as authorities in nutrition. In situations in which no dietitians are present or dietitians' skills are not recognized, pharmacists and nurses are especially likely to take over nutritional support roles traditionally assigned to the clinical dietitian. At the University of California, San Francisco, where dietitians are included in nutrition education and patient care programs and where understanding of the role of the dietitian is a stated educational goal, a preliminary survey suggests that conflicts occur in roles that are shared by members of nutritional support teams. Factors contributing to role conflicts include not only inadequate education of other health professionals but also problems of job expectations, education, training, and self-image among dietitians. Improved training in clinical nutrition, acquisition of better team and patient care skills, documentation of the effectiveness of dietetic services, and efforts to improve status and visibility would help alleviate role conflicts and ensure clinical dietitians a more rewarding place in the health care system.     

Graduates of internships and coordinated undergraduate programs--do differences exist?

Two principal routes have existed for several years for gaining credentials for dietetic practice, the dietetic internship and the coordinated program. However, comparative evaluations of the effectiveness of these programs in preparing entry-level practitioners have been limited. In this study, adequacy of educational preparation and performance of dietetic internship and coordinated program graduates was assessed at entry level and after one year of practice, using graduates' self-ratings and supervisors' evaluations. The majority of graduates who were employed in dietetic practice held clinical positions in hospitals or university medical centers. Educational preparation and level of performance of all graduates were considered to be adequate, indicating that both types of programs are preparing knowledgeable and competent entry-level practitioners. Although differences on competency measures were not reflected at entry level, intern graduates scored significantly higher than graduates of coordinated programs on administrative and clinical competencies after one year of practice. Also, at entry level and after one year, those completing internships were rated higher on two performance style measures: initiative/self-assurance and dependability. In general, supervisors' ratings tended to be higher than graduates' self-ratings.     

Factors influencing health information system adoption in American hospitals

OBJECTIVES: To study the number of health information systems (HISs), applicable to administrative, clinical, and executive decision support functionalities, adopted by acute care hospitals and to examine how hospital market, organizational, and financial factors influence HIS adoption. METHODS: A cross-sectional analysis was performed with 1441 hospitals selected from metropolitan statistical areas in the United States. Multiple data sources were merged. Six hypotheses were empirically tested by multiple regression analysis. RESULTS: HIS adoption was influenced by the hospital market, organizational, and financial factors. Larger, system-affiliated, and for-profit hospitals with more preferred provider organization contracts are more likely to adopt managerial information systems than their counterparts. Operating revenue is positively associated with HIS adoption. CONCLUSION: The study concludes that hospital organizational and financial factors influence on hospitals' strategic adoption of clinical, administrative, and managerial information systems.     

Avoidable perinatal deaths and obstetric health care structure in the public health care system: a case study in a city in greater metropolitan Rio de Janeiro

This paper investigates the occurrence of potentially avoidable perinatal deaths by associating failures in obstetric care with structural deficiencies in four maternity hospital comprising the local health care system in a city in Greater Metropolitan Rio de Janeiro in 1994. Information sources were a questionnaire, interview, observation, and hospital records. A theoretical organizational model was applied in data analysis. The four maternity hospitals showed problems in the three groups of factors used in this study: physical infrastructure, services, and equipment; organizational and administrative characteristics; and professional organization. In two maternity hospitals, the delay in cesarean deliveries was explained by deficiencies in the group of factors that includes facilities, services, and equipment. Health care failures directly associated with the physician were explained by high percentages of negative predisposing factors (mainly in the two private hospital), skill-related problems (more clearly in the two public hospitals), and by absence of measures for redirecting practice.     

Facilities for the management of patients with lipid disorders in the United Kingdom: results of the British Hyperlipidaemia Association Survey

A national survey was undertaken by the British Hyperlipidaemia Association to obtain data on the current clinical practice for the investigation and management of patients with hyperlipidaemia. An additional objective of the survey was to establish a United Kingdom register of lipid clinics. The results show a considerable variation in the availability of lipid clinics, and medical practitioners involved in these clinics came from a variety of specialty backgrounds. Some clinics had clearly defined policies with regard to acceptance of referrals. However, deficiencies in clinical services were identified including the lack of dietetic and laboratory support.     

Managerial functions of college and university foodservice managers

This study examined managerial roles in college and university foodservice at three organizational levels. The study population included foodservice managers at National Association of College and University Food Services (NACUFS) member schools with a minimum annual budget of +3 million. The 999 managers from 80 colleges and universities who participated were categorized into three groups: assistant, associate, or director of foodservice; unit manager; and manager reporting to unit manager. They rated 51 activity statements on importance and time demand. Maintaining standards of quality was rated most important and most time demanding by all three groups of managers. Perceived importance and time demand of activities increased as managerial level increased. Activity statements were categorized into Mintzberg's 10 managerial roles. Significant differences in importance and time demand ratings among the three managerial groups were indicated for all 10 roles. However, perceived importance and time demand of roles increased as managerial level increased with two exceptions. Disturbance handler and leader roles were rated more time consuming by lower level managers.     

Monitoring accountability of a clinical nutrition service

The first step in the effort to establish a stronger link between nutrition care intervention and health status is to identify actual services provided. This study examined the accountability of a clinical dietetic staff by using an explicit procedure that made it possible for performance to be measured. Data were gathered at an urban teaching hospital to determine the nutrition care provided as compared with stated standards. Using the Policy and Procedure Manual as the written standard, the authors analyzed data from medical record audit, time utilization studies, staff interviews, and monthly reports. The level of accountability was very high, with less than 1 discrepancy in 10, for all the data collected. The dietetic staff members at the hospital verified the attainment of established standards by clearly and specifically documenting their services. It would appear that a decision about priorities and responsibilities had been made that was well supported by staff and institution. The establishment of a nutrition care team, in which clinical dietitians assumed a supervisory role that promoted and supported delegation to dietetic technicians and dietetic assistants, also contributed to good performance.     

Primary care in European Union countries: configurations and organizational reforms in the 1990s

During the 1990s, proposals to contain health expenditures and demands raised by changes in the epidemiological profile led to organizational reforms in primary healthcare services in European Union countries, aimed at promoting the coordination of services provided by the various levels of care. Based on a literature review, document analysis, and interviews with key informants, the current study analyzes the institutional configurations for first-level healthcare and discusses the pre-coordination organizational reforms in the European Union countries. First-level outpatient care is provided in these countries through a wide variety of institutional configurations, observing the different financing mechanisms, range of healthcare professionals, range of clinical services provided, and the position occupied by physicians in primary care within the healthcare system. Reforms in the last decade were accompanied by a diversification in the outpatient care organizational models, with an expansion in the clinical, healthcare coordination management, and financing functions of primary care professionals, indicating a process in transition, with a redefinition of the roles played by general practitioners as the leaders of patient care.     

The societal and organizational contexts of culturally sensitive mental health services: Findings from an evaluation of bilingual/Bicultural psychiatric programs

The Hispanic mental health literature focuses mostly on cultural and clinical issues. This paper argues that researchers and practitioners concerned with mental health services for Hispanics and other minority groups need to pay more attention to the societal and organizational contexts that facilitate or impede the development of effective culturally sensitive psychiatric programs. Utilizing data from an evaluation of three New York psychiatric programs for seriously mentally ill (SMI) Hispanic patients, the paper discusses societal and organizational factors that influenced the programs’ development. Among societal forces were the significance of Hispanics as a voting bloc, the political organization of Hispanic mental health professionals, the philosophy of ethnic assimilation in American society, prevailing views about the place of cultural knowledge in psychiatric treatment, and fiscal crises, and the shortage of Hispanic mental health professionals. Among organizational factors, hospital administrative support and program leadership mediated the effects of societal forces upon the programs, while ethnic competition and lack of coordination between the program and other organizational units acted as barriers to the programs’ development. The findings are relevant to any innovative mental health service in an organizational setting.     

A problem-based nutrition care model that is diagnostic driven and allows for monitoring and managing outcomes

The provision of quality food and nutrition services is at the core of dietetic practice. It is exciting to have the profession engaged in discussions regarding the development of a standardized care process/model to further enhance the quality of nutrition services. Educators, consultants, and practitioners have already spoken on behalf of such a tool. This article demonstrates how a systematic model, when incorporated into education and practice contributes to improved provision of MNT and adds value to the unique contributions of dietetic professionals. The authors hope that the discussion will continue and that more ideas and suggestions will be forthcoming.     

Clinician managers and cultural context: comparisons between secondary and primary care.

This paper takes account of earlier work suggesting that cultural differences between clinical specialties in the hospital sector are an important indicator of the extent to which different specialties are able to engage successfully with managerial roles. This study suggested that some clinical specialties, particularly non-acute and support specialties, were more predisposed to managerial work, whereas acute clinical specialties, for example, surgical specialties, or obstetrics, tended to be more sceptical and in some cases antagonistic towards managerial work. These findings are compared with the emerging experiences of GPs faced with the challenge of similar managerial situations. The findings point to the existence of different cultural groups, or subcultures, co-existing in both the Trust and to some extent in the PCG. Some clinical specialties were prepared to share managerial values and expectations or at least go along with them, while others were antagonistic and represented a potential source of conflict. The evidence in the two sets of data points to two broadly defined groups: traditional professional and managerialist subcultures. The existence of these cultural sub-groupings is significant in terms of support for or against doctor involvement in the managerial process.     

Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition

It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship. Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individual's functional ability to eat and their nutrition status. Likewise, nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. As knowledge of the link between oral and nutrition health increases, dietetics practitioners and oral health care professionals must learn to provide screening, education, and referrals as part of comprehensive client/patient care. The provision of medical nutrition therapy, including oral and overall health, is incorporated into the Standards of Practice for registered dietitians and dietetic technicians, registered. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. Collaborative endeavors between dietetics, dentistry, medicine, and allied health professionals in research, education, and delineation of practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.