Effective partnership working: a case study of hospital discharge

The process of discharging patients from hospital provides a critical indicator of the state of partnership working between health and social care agencies. In many ways, hospital discharge can be seen to epitomise the challenges which beset partnership working. For patients who have care needs which continue following their discharge from hospital, how well health and social care partners are able to coordinate their policies and practice is critical. Where arrangements work well, patients should experience a seamless transition; where things go wrong, patients are all too often caught in the middle of contested debate between health and social care authorities over who is responsible for what. In 2002, growing concerns over the numbers of mainly elderly people who were experiencing delays in being discharged from hospital led to the announcement that a system of 'cross-charging' would be introduced to target delayed discharges which were the responsibility of local authority social services departments. The government's proposals were widely criticised and were the focus of much antagonism. The intervention of the Change Agent Team (an agency with responsibility for providing practical support to tackle delayed discharges) marked a turning point in the presentation of the policy and in supporting local implementation efforts. This paper examines partnership working between health and social care by exploring the specific issues which this case study of hospital discharge provides. The analysis highlights the importance of understanding the dynamics of partnership working on the ground. It also underlines the need for a new relationship between central government and local agencies when old-style models of command and control are no longer fit for purpose. A new approach is required that addresses the complex and multiple relationships which characterise the new partnership agenda.     

The influence of organizational jurisdiction, organizational attributes, and training measures on perceptions of public health preparedness in Alberta

Objectives  

Recent international events including the H1N1 influenza pandemic and the rising incidence of West Nile Virus throughout North America have brought critical attention to the Canadian public health system and how prepared the system is to respond to various types of contemporary public health threats. The current work assessed the association of organizational jurisdiction, organizational attributes, and training opportunities with three different measures of public health preparedness in the province of Alberta, Canada.     

The Del Rio project: a case for community-campus partnership

CONTEXT: Interdisciplinary teams of graduate health professions students and faculty were provided with experiential learning opportunities while assisting a small rural community address critical health-related issues. PROJECT OBJECTIVES: To establish an effective partnership with community leaders and area residents to assist in determining the feasibility of a new primary care clinic and to remediate a water borne disease threat. To create interdisciplinary clinical learning experiences and to develop future longitudinal learning opportunities, emphasizing primary prevention. To create a community-campus partnership with control originating in and sustained by the community. PARTNERSHIP DEVELOPMENT: An interdisciplinary team of health professions students and faculty worked with community leaders and residents to develop leadership skills, enhance infrastructure and coordinate efforts to address health concerns. A health marketing analysis and a series of year-long environmental assessments of surface and ground water were completed. The community was assisted with reaching consensus for future actions, emphasizing local control, enhanced county-based ownership, and sustainability of intervention efforts. OUTCOMES AND IMPLICATIONS: The Del Rio and East Tennessee State University partnership was instrumental in accomplishing its short-term objectives with the remediation of two major health issues. The more important long-term objectives of enhancing citizen leadership skills and developing a more action-oriented community infrastructure were also met. Using an experiential learning model, students practiced community organization skills, conflict resolution and problem-solving strategies. The campus-community partnership illustrated the advantages of experiential, multidisciplinary education and accentuated the positive aspects of collaborative planning and action. The partnership continues to provide expanded learning opportunities for students and contributes to the empowerment and self-sufficiency of the community. The ripple effects of the model have become evident, with dramatic increases in university-wide efforts to increase partnership opportunities and enhanced support for service learning throughout the region.     

Strengthening affective organizational commitment: the influence of fairness perceptions of management practices and underlying employee cynicism

This study investigates the relationship between cynicism, the perceived fairness of change management and personnel practices, and affective organizational commitment. High levels of affective organizational commitment have been shown to reduce voluntary turnover in the nursing workforce. Previous research suggests that "unfair" management practices and employee cynicism lead to lower commitment. It is not clear, however, whether the perceived fairness of particular practices influences affective commitment beyond that accounted for by underlying employee cynicism. Data were obtained from a study involving 1104 registered nurses that formed part of a larger investigation of the general well-being of nurses in Western Australia. Only nurses who were permanent or employed on fixed term or temporary contracts were included. Findings indicated that although higher levels of cynicism among nurses were associated with lower levels of affective commitment, their perception of the fairness of change management and personnel practices influenced their affective commitment over and above their cynicism. The perceived fairness of management practices is an important influence on nurses' affective commitment beyond that accounted for by cynicism. The implication for managers is that the affective organizational commitment of nurses is likely to be strengthened by addressing the perceived fairness of change management and personnel practices notwithstanding their beliefs about the integrity of the organization.     

A partnership approach to health promotion: a case study from Northern Ireland

In recent years there has been a renewal of interest in community development and partnership approaches in the delivery of health and social services in Northern Ireland. The general thrust of these approaches is that local communities can be organized to address health and social needs and to work with government agencies, voluntary bodies and local authorities in delivering services and local solutions to problems. Since the Ottawa Charter was launched in 1986, government in Northern Ireland has stressed that community development should no longer simply be added on to key aspects of Health and Social Services, but should instead be at the core of their work. There is increasing consensus that traditional approaches to improving health and well-being, which have focused on the individual, are paternalistic and have failed to tackle inequalities effectively. Partnerships within a community development setting have been heralded as a means to facilitate participation and empowerment. This paper outlines the policy background to community development approaches in health promotion and delivery in Northern Ireland. Drawing on evidence from a case study of a community health project it highlights the benefits and difficulties with this approach. The findings suggest that partnerships can positively influence a community's health status, but in order to be effective they require effective planning and long-term commitment from both the state and the local community.     

Shifting the burden of health care finance: a case study of public-private partnership in Singapore

Since becoming independent in 1965, Singapore has attained high standards in health care provision while successfully transferring a substantial portion of the health care burden to the private sector. The government's share of total health care expenditure contracted from 50% in 1965 to 25% in 2000. At first glance, the efficiency-driven health care financing reforms which emphasize individual over state responsibility appear to have been implemented at the expense of equity. On closer examination, however, Singaporeans themselves seem unconcerned about any perceived inequity of the system. Indeed, they appear content to pay part of their medical expenses, plus additional monies if they demand a higher level of services. In fact, access to needed care for the poor is explicitly guaranteed. Mechanisms also exist to protect against financial impoverishment resulting from catastrophic illness. Singapore's experience provides an interesting case study in public-private partnership, illustrating how a hard-headed approach to health policy can achieve national health goals while balancing efficiency and equity concerns.     

How organizational culture influences holistic review: a qualitative multiple case study

Advances in Health Sciences Education - Studies primarily involving single health professions programs suggest that holistic review in admissions can increase underrepresented minority (URM)...     

Women's perceptions of preventive examinations for cervical-uterine cancer: a case study

Cervical-uterine cancer is among the most feared chronic degenerative diseases, due its high mortality and morbidity rates. This study describes women's feelings before a preventive examination for cervical-uterine cancer, through a case study based on observations and semi-structured interviews as data collection techniques. A total of 24 women were interviewed, between eighteen and sixty years old, who attended the cancer prevention unit at a basic healthcare clinic in Fortaleza, Ceará State between April and August 2004. This study shows that women generally request these preventive examinations only when symptoms appear. They view this procedure with apprehension and fear, due to the possibility of a positive diagnosis of cervical-uterine cancer; they feel embarrassed at exposing their bodies for examination, particularly by male physicians; and they are poorly informed about their own bodies and even their own sexuality. These findings highlight the need for healthcare practitioners to conduct educational activities for women, in order to enhance professional relationships between healthcare providers and users, helping lower the rate of this type of cancer through more frequent preventive examinations.     

Patients' perceptions of physicians: a pilot study of the influence of prime-time fictional medical shows

Much criticism has fallen onto prime-time crime shows for skewing the perception the public has on crime. Could the same criticism apply to prime-time medical dramas, which tend to be among the most watched television shows today, for skewing patients' expectations? In the past, physicians on prime-time fictional medical shows tended to be depicted in a positive manner. However, today's medical dramas often portray physicians in a less positive context. The results of this study showed that television exposure only negatively affect patients' perceptions of physicians in regards to physical attractiveness and character, but not to physician propriety, power, communication, sociability, extroversion, competence, and composure. In addition, this study showed that prime-time fictional shows affect patient-physician interactions.     

Managing the workforce reduction: hospital CEO perceptions of organizational dysfunction

Over the past few years many nations have undertaken activities aimed at restructuring and reengineering their health system as a means of achieving greater cost effectiveness and consumer responsiveness. Most efforts at reforming healthcare delivery have been accompanied by the downsizing of healthcare organizations. Organizations that are undergoing decline or significant workforce contractions are widely believed to experience a number of negative or dysfunctional attributes as a consequence of reductions in, or redeployments of, their labor force. For organizations undergoing planned workforce reductions, much speculation has been made in an attempt to identify a set of "best practices" that have the potential to mitigate the dysfunctional consequences associated with large permanent reductions in the workforce. This article explores the relationships among workforce-reduction practices and perceptions of organizational dysfunction in a large sample of Canadian hospitals. Results of the analysis suggest that the application of certain "progressive" workforce-reduction practices preceding, during, and subsequent to the downsizing process may play an important role in mitigating some of these dysfunctional organizational consequences. This research provides some evidence to suggest that how a workforce reduction is carried out may have a greater effect on organizational effectiveness than either the magnitude or severity of the overall workforce reduction.     

Social support in unaccompanied asylum-seeking boys: a case study

Background The situation of unaccompanied asylum‐seeking children (UASC) is characterized by a substantial disruption of the social network and loss of parental support, seriously jeopardizing their psychological well‐being. However, little is known about the role of social support in the lives of UASC. Methods Twelve UASC completed a social support instrument and interview exploring perceived social support and what this implies for both buffering and main effects of social support. Results Asylum centre staff and the ethnic community were the most important resources of support. High importance was ascribed to social companionship as a way of coping. Despite pro‐social efforts towards Belgian peers, this group provided hardly any social support. Conclusions The provision of social support could enhance UASC's well‐being through buffering effects (e.g. social companionship as avoidant/distractive coping) and main effects (acceptance by Belgian peers enhancing self‐esteem). The asylum centre shows a great potential to stimulate UASC's psychological well‐being by expanding the psychosocial function of staff members and community treatment.     

The influence of waiting times on cost-effectiveness: a case study of colorectal cancer mass screening

When a cost-effectiveness analysis is implemented, the health-care system is usually assumed to adjust smoothly to the proposed new strategy. However, technological innovations in health care may often induce friction in the organization of care supply, implying the congestion of services and subsequent waiting times. Our objective here is to measure how these short run rigidities can challenge cost-effectiveness recommendations favorable to an innovative mass screening test for colorectal cancer. Using Markov modeling, we compare the standard Guaiac fecal occult blood test (gFOBT) with an innovative screening test for colorectal cancer, namely the immunological fecal occult blood test (iFOBT). Waiting time can occur between a positive screening test and the subsequent confirmation colonoscopy. Five scenarios are considered for iFOBT: no further waiting time compared with gFOBT, twice as much waiting time for a period of 5 or 10 years, and twice as much waiting time for a period of 5 or 10 years combined with a 25 % decrease in participation to confirmation colonoscopies. According to our modeling, compared with gFOBT, iFOBT would approximately double colonoscopy demand. Probabilistic sensitivity analysis enables concluding that the waiting time significantly increases the uncertainty surrounding recommendations favorable to iFOBT if it induces a decrease in the adherence rate for confirmation colonoscopy.     

Lessons learned from a decade of partnership between PEPFAR and the Global Fund: a case study from Tanzania

The President's Emergency Plan for AIDS Relief was intended to be complementary to existing US work to fight HIV/AIDS through the broader multilateral efforts of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. This article explores the history of this collaboration, highlighting lessons learned through a case study of Tanzania and challenges overcome through ongoing improvements, such as ensuring reliable access to antiretroviral drugs. Improved communication and a more formalized partnership between PEPFAR's bilateral efforts and the Global Fund have been key to improving health outcomes in Tanzania, and this case can be used as a model for other countries. If PEPFAR is reauthorized in 2013, its partnership with the Global Fund should be further formalized and expanded.     

An organizational case study of the case manager's role in a client's return-to-work programme in Australia

The purpose of this study was to examine the case manager's role in a return-to-work programme in Sydney, Australia. The investigators examined the case manager's role assumed by occupational therapists, physiotherapists, psychologists and rehabilitation counsellors when providing occupational rehabilitation services. Files of closed cases (n=172) were examined to investigate the relationship between the case manager's profession and return-to-work outcomes. It was found that the provider of occupational rehabilitation examined in this study achieved above-average return-to-work rates (83%), with no significant difference between case managers. There was, however, a significant relationship between the client's type of injury and the case manager (p<0.001), and case length was significantly different between case managers (p=0.004). The occupational therapist had the largest case management load (43%), followed by the rehabilitation counsellor (23%). There were trends (0.05相似文献   

Rationalization as a key stressor for public sector employees: An organizational case study

Public sector organizations throughout Europe have been subjectto cuts in Government spending, allied to demands for enhancedefficiency and effectiveness. Consequently, many have embarkedupon radical programmes of change which potentially have anadverse effect upon the psychological well-being of employees.This study aimed to assess linkages between organization changeand the psychological well-being of employees within the Swedishsocial insurance organization Försäkringskassan. Acase study approach was adopted for the investigation whichwas carried out within the Halland region between February andJune 1995. A questionnaire which included the Cultural Auditand the General Well Being Questionnaire was distributed tothe organization's 456 employees in Halland. Questionnaireswere returned by 246 employees (54.6%), reflecting the employmentstructure of the organization. The findings revealed that manyissues associated with the process of rationalization and changewere of concern to employees. Statistical analyses revealedthat these were linked to their relatively high levels of ‘anxiety’and their symptoms of being ‘worn out’. This studyindicates that the process of organization change is stressfulfor employees within Försäkringskassan. As publicsector organizations throughout Europe are subject to similarpressures and are being forced to embark upon change programmes,it is suggested that they take cognizance of the findings ofthis investigation when making decisions regarding the planningand implementation of organization change.     

公立医院非编制人员组织支持感、组织认同与工作投入的关系研究

目的:探讨中国人事制度背景下公立医院非编制人员的组织支持感、组织认同对工作投入的影响过程和影响机制,为医院管理者采取措施促进非编制人员的工作投入提供参考。方法:采用组织支持感问卷、组织认同量表和工作投入量表,对四川某市6所市属三级公立医院的650名非编制人员进行调查,采用SPSS19.0进行描述性分析、相关分析、回归分析,采用AMOS17.0建立3个变量的结构方程模型。结果:公立医院非编制人员的组织支持感总均分为(2.80±1.05)分,组织认同总均分为(3.73±1.03)分,工作投入总均分为(2.99±1.58)分;组织支持感、组织认同与工作投入呈两两显著正相关(P0.01);组织支持感对工作投入有直接效应,并能以组织认同为中介变量对其产生间接效应。结论:公立医院非编制人员组织支持感、工作投入程度处于较低水平,公立医院管理者可以通过提高非编制人员组织支持感及组织认同感促进工作投入。