Task and structural correlates of organizational effectiveness in private psychiatric hospitals.

This exploration of the relationships between task and structural variables and two dimensions of organizational effectiveness in 76 private psychiatric hospitals revealed that high levels of centralization were associated with patient care effectiveness. High levels of centralization and formalization were associated with administrative effectiveness. An enhancing effect of organizational structure is suggested as contributing to organizational effectiveness.     

Employees' views of their work experience in private hospitals.

Employees in 10 private for-profit hospitals responded to questionnaires regarding their work experiences, hospital facilities, and employer. Replicated results identified themes of employee opinions, including: Supervision, The Employer, Role Significance, Hospital Image, Competitiveness, Benefits, Cohesiveness, and Work Load. Only scores on the Role Significance scale differed between clinical and non-clinical respondents, with the former scoring higher. Survey methodology can be used to define an organization's culture from the employee's viewpoint. Their perception of this culture helps determine their behavior at work and their conveying the image of their facility in the community. The recent emphasis on quality improvement and 'bottom-up' management presents a particularly well-suited opportunity for the effective use of surveys. Quality improvement efforts involve employee groups which empower workers as active diagnosticians, internal consultants, and decision markers. Survey defined 'action levers' portray avenues along which such constructive efforts might be directed. Also, surveys identify themes through which management can evaluate organizational performance overall and department by department, building in means by which those responsible for units of the hospital can be accountable for achieving measurable results.     

The use of state and general hospitals for inpatient psychiatric care.

OBJECTIVES: This paper explores the relationship of state hospital and general hospital psychiatric caseloads in a statewide system of care. METHODS: Probabilistic population estimation was applied to general hospital and state hospital data sets. RESULTS: General hospitals provide inpatient psychiatric services to more people than do state hospitals, and a significant number are served in both sectors. There were notable differences in use patterns related to patient gender and age. CONCLUSIONS: These results demonstrate that probabilistic methodologies can significantly enhance the value of existing databases for epidemiological research.     

民营医院履行社会责任的实践探索

介绍了我院作为改制后的民营医院,在医院文化建设方面,通过创建爱康医院家的文化,树立爱康价值观,构建和谐的医院工作环境;在管理体制改革方面,实施管办分离,成立了支持系统和运营系统,通过先进的管理方法改进医疗服务质量;在回报社会方面,通过积极救助弱势群体、积极承担公共卫生服务、热心慈善等,付出真诚的爱心,切实履行社会责任.

Abstract：

The paper introduced the organization culture building of a private hospital, in creating the Aikang hospital as your home culture and Aikang values for building a harmonious workplace for the hospital. The management system reform features the separation between regulations and management,building of the supporting system and operating system, for better quality of care with advanced management practice. The social rewards feature great efforts in supporting the disadvantageous population, and undertaking public health service and charity activities. These care and love to the community help the hospital to fulfill its social responsibilities.     

Utilization of local jails and general hospitals by state psychiatric center patients

The idea that the deinstitutionalization of state psychiatric centers has resulted in increased utilization of general hospitals and correctional facilities by people with severe and persistent mental illness is widely held. This hypothesis of transinstitutionalization was tested by examining hospitalization and incarceration rates of people who had been or would be institutionalized in state psychiatric centers in 16 upstate New York counties. The results do not support the hypothesis of transinstitutionalization. Assumptions underlying the hypothesis are examined, potential explanations for the observed patterns are discussed, and areas for further research are suggested.     

Unplanned admissions to inpatient psychiatric treatment and services received prior to admission

BackgroundInpatient bed numbers are continually being reduced but are not being replaced with adequate alternatives in primary health care. There is a considerable risk that eventually all inpatient treatment will be unplanned, because planned or elective treatments are superseded by urgent needs when capacity is reduced.Aims of the studyTo estimate the rate of unplanned admissions to inpatient psychiatric treatment facilities in Norway and analyse the difference between patients with unplanned and planned admissions regarding services received during the three months prior to admission as well as clinical, demographical and socioeconomic characteristics of patients.MethodUnplanned admissions were defined as all urgent and involuntary admissions including unplanned readmissions. National mapping of inpatients was conducted in all inpatient treatment psychiatric wards in Norway on a specific date in 2012. Binary logit regressions were performed to compare patients who had unplanned admissions with patients who had planned admissions (i.e., the analyses were conditioned on admission to inpatient psychiatric treatment).ResultsPatients with high risk of unplanned admission are suffering from severe mental illness, have low functional level indicated by the need for housing services, high risk for suicide attempt and of being violent, low education and born outside Norway.ConclusionSpecialist mental health services should support the local services in their efforts to prevent unplanned admissions by providing counselling, short inpatient stays, outpatient treatment and ambulatory outpatient psychiatry services.Implications for health policiesThis paper suggests the rate of unplanned admissions as a quality indicator and considers the introduction of economic incentives in the income models at both service levels.     

Caries prevalence and state of treatment in the case of Koblenz children in the first school class with reference to district-related social indicators

The findings of the dental medical examinations of the school years 1996/1997 and 1997/1998 in the first classes of primary schools in Koblenz have been associated with district-related social indicators given in the social report for Koblenz, and more especially the "proportion of recipients of social welfare assistance among the 0-13 year-olds" indicator. The caries prevalence indices as well as the treatment deficits, the proportion of those needing treatment and the proportion of children with increased risk of caries clearly increased parallel with the proportion of social welfare assistance amongst the children although the greatest difference was seen in the case of districts with average social welfare assistance density and such with high/very high social welfare assistance density. Even at individual school levels a close connection could be established between the proportion of social welfare assistance recipients amongst the 0-13 year-olds in the school district and a) the proportion of children with increased caries risk in accordance with DAJ (Deutsche Arbeitsgemeinschaft für Jugendzahnpflege) criteria (r(s) = + 0.881) as well as b) a multi-factorial "first school class dental health index" (EZI) (which covered both prevalence and treatment parameters and also findings below the risk threshold of the DAJ criteria) developed for comparing the schools with each other (r(s) = + 0.825). The six "risk schools" (from 22 primary schools) determined by a) the proportion of children with increased caries risk according to DAJ criteria, b) the multi-factorial EZI and c) the social welfare assistance proportion amongst the 0-13 year-olds in the school district, are identical. In comparison with the complex multi-factorial first school class dental health index (EZI), the study confirms the general suitability of the "proportion of children with increased caries risk" for the identification of schools with above-average deficit in dental health care. However, at the same time such "risk schools" - at least in the towns with documented social differentiation of the resident population in the various town districts - can also be determined by the district-related social indicators. This may be significant in such cases where there are no dental examination results (determined according to uniform criteria) available for all schools in one town or region, but specific measures (for example examinations, prevention, fluoridation) should be concentrated on schools with greater need for such measures.     

Trends in lung cancer mortality in Scotland and their relation to cigarette smoking and social class.

This paper describes the trends in lung cancer rates in Scottish men and women during 1959-85, the relationship between lung cancer and cigarette consumption, and between lung cancer and social class, and the urban-rural gradient of lung cancer. Lung cancer rates in Scottish men have declined in all age groups under the age of 74 for at least the past two decades; the most notable decrease was in men aged 40-44 years, whose rates halved between 1970 and 1980. In women, who began smoking in large numbers only after World War II, lung cancer mortality declined slightly in those between 40-54 years and rose in those over 54 years. Trends in cigarette consumption did not fully explain the decline in lung cancer. Marked urban-rural gradients in the SMRs for lung cancer were evident in all periods, and these strengthened over time. Correlations between lung cancer and social class differed markedly from those found in previous studies, except for those with social classes II and V.     

Source of admission and cost: public hospitals face financial risk.

We studied all admissions to the 11 acute care hospitals of the New York City Health and Hospitals Corporation (April 1983-September 1984) matching emergency room (ER) admitted diagnostic related group (DRG) subgroups in each hospital with at least five non-ER admitted patients (N = 222,961). Mean cost per ER patient ($8,385) was greater than non-ER mean cost per patient ($4,386) for Medicare and non-Medicare. Our data suggest that public hospitals with a high proportion of ER admissions may be at a financial disadvantage under DRG reimbursement.     

Anorexia nervosa and social class.

OBJECTIVES: (1) To examine social class status of female patients with anorexia nervosa presenting over a 33-year period; (2) to identify any differences in clinical features between the social classes. METHOD: Retrospective survey using comprehensive clinical database of patients referred to a national specialist center for the assessment and treatment of anorexia nervosa. Social class was defined using UK Registrar General's classification of father's occupation. Statistical methods included initial univariate analyses and subsequent ordinal logistic regression. RESULTS: (1) Social class distribution was consistently weighted toward social classes 1/2. (2) Possible clinical indicators examined included low body weight, binge eating, and consequent weight-regulatory behaviors such as vomiting and laxative and diuretic misuse. These clinical features and their distribution proved to be similar across the social groups. Clinically rated quality of family relationships and types of family constellations were also consistent across the social classes. (3) Dieting prodromata and onset of the disorder occurred at younger ages in social classes 1/2. (4) A modest shift in social class distribution over time was apparent, with slightly more patients presenting post-1985 likely to come from lower social classes. Claims that the social class distribution is a product of referral patterns and acceptances are disputed. CONCLUSION: We suggest that the social class bias reflects a sociocultural influence; a product of the disorder significantly often arising as an avoidant response to the conflict between social class-related family values/attitudes and adolescent turbulence within that family.