The National Institute for Program Director Development: a school for program directors

BACKGROUND: The role of residency program director is unique in medicine and medical education. Most program directors learn the job through trial and error, with a fortunate few benefiting from the wisdom and experience of their predecessors and mentors. In 1994, the Association of Family Practice Residency Directors (AFPRD) made the development of training and support resources for program directors a top priority. METHODS: With the support of the strategic plan of the AFPRD, the focus on excellence in residency education by the ABFP, and a survey documenting need, the National Institute for Program Director Development (NIPDD) was formed, with its sentinel product, a school for family practice residency directors. RESULTS: A fellowship-format 9-month training program was constructed using a multidimensional educational model. To date, there have been more than 300 participants. The curriculum emphasizes leadership development, resource allocation, a thorough familiarity with regulations and standards, educational options, and personnel management skills. A follow-up survey in 1999 documented an increase in program director tenure and an overall positive impact on family practice residency programs. CONCLUSIONS: Enhanced preparation for the job of residency program director results in a positive impact on both the director and the program.     

Improving care, reducing costs. Careful planning and ongoing education are key to a successful care management program

Introduced in 1990, the care management program at St. Peter's Medical Center, New Brunswick, NJ, has had a growing impact on the facility's operations and bottom line. To introduce the program, care managers and nursing administrators conducted in-services for nurses and other personnel. At the same time, the vice president for nursing and the project director for care management introduced the concept to members of the medical staff likely to admit patients who fell into the care management population. Once selected, St. Peter's care managers go through an extensive orientation program consisting of three weeks of classroom instruction and three weeks of on-the-job training. Classroom training emphasizes business skills necessary to facilitate effective utilization of resources while ensuring that patients' needs and concerns are understood and addressed. On-the-job training helps new care managers apply the St. Peter's care management model. This careful preparation, along with continuing education for all practitioners, has helped win support throughout the facility for the care management approach. The St. Peter's care management department currently employs eight nurse care managers who help coordinate care for 16 diagnoses.     

Leadership and quality of working life in home health care

Home health care has undergone startling changes in the past decade and, in the process, become a strategically important ingredient of health care delivery. However, the question remains whether home health care organizations can deliver the benefits anticipated for integrated care delivery systems. The answer to this question depends to a great extent on whether home health care organizations build vibrant, visionary leadership capable of transforming organizations and motivating staff to deliver high quality and low cost services. This paper examines a case study of transformational leadership as it relates to the quality of working life for nurses, homemakers, and staff. The findings indicate that leader behaviour is strongly associated with homemakers', and to a lesser extent staff members', job satisfaction, job involvement, and propensity to remain with the organization. These job attitudes have been shown to be related to higher job performance. The implications for leadership in home health agencies are discussed.     

Leadership and Quality of Working Life in Home Health Care

Home health care has undergone startling changes in the past decade and, in the process, become a strategically important ingredient of health care delivery. However, the question remains whether home health care organizations can deliver the benefits anticipated for integrated care delivery systems. The answer to this question depends to a great extent on whether home health care organizations build vibrant, visionary leadership capable of transforming organizations and motivating staff to deliver high quality and low cost services. This paper examines a case study of transformational leadership as it relates to the quality of working life for nurses, homemakers, and staff. The findings indicate that leader behavior is strongly associated with homemakers', and to a lesser extent staff members', job satisfaction, job involvement, and propensity to remain with the organization. These job attitudes have been shown to be related to higher job performance. The implications for leadership in home health agencies are discussed.     

护理部干事配合主任工作的技巧与成效

目的探讨提高护理部干事工作质量的方法。方法通过运用摆正角色位置、主动服务、协调沟通周全、办事抓重点、讲效率等工作技巧,提高工作效率和质量。结果提高了工作效率和质量,当好了领导的助手和参谋。结论通过运用一定的工作技巧和方法,创造性地配合主任工作可提高工作效率和质量,处理好各部门之间的关系,得到院领导和各临床科室同事的认可和好评,体现工作价值。     

当好医疗副院长应具备的六种意识

医疗副院长必须具备六种意识：（１）找准副院长的“为政坐标”增强角色意识;（２）以副为乐,树立院长的核心地位意识;（２）放弃自我,提高配合意识;（４）忍辱负重,强化大局意识;（５）防止越位,要有自觉的到位意识;（６）积极主动,要有谋事、揽事意识。     

Connecting the disconnected: adult day care for people with AIDS in New York City.

Despite pressing need, the development of a continuum of long-term-care services for people with acquired immune deficiency syndrome (AIDS) has been hampered by the dearth of information on the characteristics and service needs of patients eligible for such care. This article presents findings from a process evaluation of an outpatient day care program for people with AIDS in New York City. The AIDS clients were highly functional but had a diverse range of needs and problems related to housing, substance abuse, medical care, and social support. The majority of clients reported being very satisfied with the level of staff support and with the overall program. The findings of the study suggest that day care is a valuable addition to the continuum of services and that the creative dissemination of this program may improve the delivery of services to people with AIDS.     

The potholed path to becoming a physician executive

This article discusses evolving career pathways for physician executives--pathways that take physicians out of primarily patient care roles and into management activities. The discussion is textured with "how-to" advice for readers who may have aspirations of becoming physician managers and executives. The advice stems from my own experiences in the pharmaceutical industry and other healthcare sectors. Specific topics addressed include: attending business school, gaining management experience, working in large corporations, dealing with job loss, acquiring both hard and soft skills, cultivating mentors, and developing leadership competencies. Physician executives must demonstrate strong leadership abilities and learn how to tactfully confront difficult people and problems.     

Silent and invisible; nursing home residents with advanced dementia

The Namaste Care Program is designed to provide meaningful activities through therapeutic touch, music and life review to nursing home residents with advanced dementia. This program has improved resident care, staff and family satisfaction while increasing census. Namaste Care is easy to initiate and does not require additional staff or expensive supplies. The experience of one long-term care company EPOCH Senior Living of Waltham Massachusetts USA which offers Namaste Care in their skilled nursing facilities is explained. Management has concluded that program has been an important addition to the services they provide for residents and their families from both a business prospective and a quality of care standpoint.     

The importance of leadership style and psychosocial work environment to staff‐assessed quality of care: implications for home help services

Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross‐sectional survey design was used and a total of 469 questionnaires were distributed (March–April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members.     

Health care administration in the year 2000: practitioners' views of future issues and job requirements

This research identifies the most important domains in health care administration (HCA) from now to the year 2000 and differentiates job skill, knowledge, and ability requirements necessary for successful management. Fellows of the American College of Healthcare Executives from about half of the United States responded to two iterations of a Delphi mail inquiry. Fellows identified 102 issues that were content-analyzed into nine domains by an HCA expert panel. Domains, in order of ranked importance, were cost/finance, leadership, professional staff interactions, health care delivery concepts, accessibility, ethics, quality/risk management, technology, and marketing. In the second Delphi iteration, Fellows reviewed domain results and rated job requirements on required job importance. Results indicated that while a business orientation is needed for organizational survival, an equal emphasis on person-oriented skills, knowledge, and abilities is required.     

The Changing Nature of Management in Child Care Centres in Queensland: A Review of Directors' Perspectives

The aim of this paper is to produce an understanding of directors' work; perceptions of their role as managers in the centre; their experiences; and the nature of management within the context of the child care field in a complex social, legislative and economic climate. In the current context of the delivery of child care services in a market-driven climate, the language of business and organisational theory has entered the lexicon of the early childhood field. The findings indicate that the director of a child care centre needs to have knowledge, skills and experience in business management to enhance their competencies for management of centres in today's competitive environment.     

Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

Background

Mulago National Referral Hospital (MNRH), Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH.

Methods

Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis.

Results

Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications.Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills.

Conclusions

Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda.

     

军队医院护理工作的现状

为探讨军队医院护理工作的现状,采用了对部分医院领导、护理部主任、科室主任进行问卷式调查的方法。通过对调查资料的统计分析,对当前护理工作的几个难点问题有了比较全面、客观地了解;并提出了切实加强对护理工作的领导;加强护理队伍建设,提高护理人员整体素质;积极开展整体护理模式,全面提高护理质量等有关对策。     

Should Programs of All-Inclusive Care for the Elderly Use Community-Based Primary Care Physicians?

The program of All-inclusive Care for the Elderly (PACE) is a community-based, long-term care model designed for older adults that are nursing home eligible. Bound by original design and regulations, these programs have primarily utilized a center-based ("staff") primary care physician model. However, some believe that this might hinder expansion of the PACE model. In response to this concern, three PACE programs have explored the use of "community-based" primary care physicians (CBPCPs). In an attempt to evaluate the impact of this variation in the model, we surveyed the medical director, 2 community-based primary care physicians and 6 non-physician staff members at one of these sites. Responders generally support the use of CBPCPs as a useful and productive alternative way to expand PACE services to a wider audience of eligible patients. Because some staff members perceive that CBPCPs utilize hospital and NH services at a higher rate, continued education of both CBPCPs and staff members regarding the expectations from this relationship is needed.     

Developing effective physician leaders: changing cultures and transforming organizations

In this article, the authors discuss the problematic issue of transformational change in the face of cultural conflict between the worlds of clinical care and organizational leadership, and describe a case study of organizational cultural change facilitated through a physician leadership development program. A locally developed physician leadership program can be extremely effective at both improving physicians' leadership skills and increasing understanding of the strategic goals and direction of the organization. The transformational change required for physicians to develop and appreciate business and leadership skills can be supported and encouraged in a leadership development program that includes the components of careful curriculum design, program monitoring, and opportunities to apply new skills in practice. For Columbus Children's Hospital, Columbus, Ohio, this organizational transformational change effort was successfully achieved when a new medical leadership development program helped academic and community physicians to become involved in organizational leadership. The authors describe the background and development of this program and provide results of their evaluation of the program, with discussion of future extensions to the program.