Love stories: understanding the caring journeys of aged Greek‐Australian carers

This article documents the findings of a short‐term longitudinal study that explored the caring journeys of aged Greek carers providing in‐home care for their spouse. Through a deeper understanding of carers’ decisions and decision‐making and insights from service providers and community leaders, we aimed to inform policy makers, service managers and providers about how to develop and promote culturally appropriate support services, and negotiate them with carers and care recipients in a timely way. Initially, we conducted three focus groups and one follow‐up forum with service providers and Greek community leaders. Then, over a 6‐month period, we conducted two in‐home interviews and two telephone interviews with 12 older Greek carers. We sought to understand factors influencing carers’ decision‐making regarding service uptake, and we provided information about services as required. Through our thematic analysis, we found that most carers wanted to remain as independent as possible and to avoid forced separation from the one they loved, through institutionalisation. They placed great value on their caring role which, while a struggle at times, gave them a sense of meaning, purpose and belonging. We also found that carers had great resourcefulness, strength and competence. They were all in long‐term relationships, had negotiated coming to a foreign country and establishing themselves and were now in the process of negotiating old age and increasing frailty while at the same time providing care and support to family and friends. Our findings suggest that services need to be communicated in ways which support what carers value, not on outdated assumptions about cultural groups, otherwise providers will perpetuate exclusion. We propose an outreach in‐home service model with an emphasis on ageing well and staying at home. This model of service provision is a model of care which emphasises relationships and community, and seeks to build social and cultural capital.     

Maintaining prophetic cultures

The Catholic health ministry was founded by "prophetic people," people who shared some of the qualities shown by biblical prophets. If it is to endure and prosper, Catholic health care must foster prophetic cultures-cultures that positively encourage the development of new leaders possessing prophetic qualities. The Scriptures, particularly the Hebrew Scriptures, eloquently describe the characteristics these new leaders will require. The chief qualities that will be needed are memory (of the Hebrew and Christian tradition), creative imagination, orientation toward the community, steadfastness in commitment, patience in adversity, humility, a sense of humor, and an ability to express lamentation. To foster prophetic cultures, sponsors and board members must perform certain actions. They must act hopefully, set high standards, and clarify four leadership functions: conserve the organization's mission, manage resources efficiently, empower associates, and encourage everyone involved to respond to problems creatively.     

Finishing big by starting small. Continuous improvement is the key to enhancing community health

Although healthcare organizations increasingly seek involvement in community health improvement, they are often unprepared to do so because of their inexperience in disease and injury prevention. In recent years, however, continuous improvement (Cl) methodology has produced insights that are useful in such projects. An organization considering a community health improvement project should, from the start, test it through "Plan, Do, Study, Act" (PDSA) cycles. The project's leaders should begin by selecting an issue to work on. They must accurately define the community and involve its members in the project, because health improvement work is most effective when the people who care most strongly about a problem help solve it. Leaders should clearly define the project's aim, perhaps through analyzing hospital records and other databases. In forming a collaborative group to work on the project, leaders should begin with a "core team," perhaps adding other members later. This team should track data using three kinds of measurement--global, intermediate, and process--building data evaluation into its daily practices. The team would do well to get the guidance of someone familiar with Cl methodology. It should also use a process involving regular meetings, time lines, a means of communicating with experts outside the area, and a format that enables it to document progress and capture lessons learned.     

"Spiritlinking": a key to dynamic change. Fostering chaos enables leaders to form the networks and unity needed to fulfill their mission

To contend with the anxiety and chaos inherent in rapid change, leaders can turn to ?spiritlinking,? the deliberate and untiring act of building the high-energy networks where new ideas are born and new ways of delivering service take form. Spiritlinking leaders are able to envision and promote the paradox of disequilibrium. They seek truth, pushing the organization into a condition of imbalance where staid settledness gives way to new paradigms founded on constant transformation. Spiritlinking leaders are not bound by organizational charts. They have discovered that the greater the participation in the organization, the greater the access to vast amounts of information and insight, which will ultimately lead to profound transformation. Spiritlinking is directed toward networking, community forming, and coalition building, often across chasms of ideological differences. Leaders must have the skill to manage the vision, which entails generating courage and belief through the cloudiness of ambiguity. Spiritlinking leaders must also create synergy from conflict, gathering strong-minded, self-assured persons who perhaps hold vastly differing perspectives, yet, in working for the common good, arrive at surprising, wonderful decisions. Finally, spiritlinking leaders assist the organization in working through resistance by identifying the mode, motive, and meaning of the resistant behavior and determining the action the organization is willing to take to move beyond it.     

Developing community indicators to promote the health and well-being of older people

As the US population ages and the number of older people who are "aging in place" increases, communities will face new opportunities and challenges in responding to this population's desires and needs. Qualitative research was conducted to inform the development of a model of an "elder-friendly community" and a set of indicators to measure and help improve community capacity to promote the health and well-being of older residents. Focus groups were conducted in four US cities with younger and older adults and community leaders who identified attributes that make a community a good place in which to grow old. The group interactions were videotaped, transcribed, and analyzed to identify common themes. Results were remarkably similar across sites. Participants said that a community could be considered elder-friendly if it helped older residents continue active participation in the community, sustain their independence, and reduce the risk of isolation. A model of an elder-friendly community, along with corresponding indicators, was created on the basis of focus group results. These tools are being tested in 10 pilot communities to determine their usefulness for measuring older people's health and well-being, prioritizing aging issues, and stimulating and informing action strategies to improve community "elder-friendliness."     

Managing in the New Zealand health service. The interpretation of experience

This paper investigates the managerial life and experiences of a group of service leaders in one region of the New Zealand health service. Through a complexity map methodology, creative interviewing, participant storytelling and presentation of their experiential narratives, the paper seeks to investigate how service leaders make sense of their complexity. First, the paper outlines the New Zealand health service context. Second, the paper introduces the sample of managers involved in the study. Third, the methodological framework of the study is outlined. Fourth, the data collected are described in the context of Gabriel's "tropes of story work". Fifth, the concept of "narrative thought" is introduced to interpret the use of attributions by health service managers as a means of fulfilling their needs and desires. The paper concludes by suggesting that through narrative sense-making managers are able to maintain a strong sense of self and identity even in stressful, pressurised, difficult and complex circumstances.     

The influence model of sponsorship. A Catholic hospital is now part of the "Mayo Clinic"

Saint Marys Hospital was founded in Rochester, MN, in 1889. Constructed by the Sisters of St. Francis, it was staffed by physician members of the local Mayo family. The Mayo practice grew into an association of many physicians and medical residents who later began to staff Rochester Methodist Hospital also; the three healthcare institutions became collectively known as the "Mayo Clinic." By the mid-1980s, billing was so complex for the three still-independent facilities that their leaders decided to integrate more formally. This was done in three phases and resulted in the creation of a single institution known as the Mayo Medical Center. From Saint Marys' standpoint, the facilitating document in this process was a "Sponsorship Agreement" whose purpose was to maintain the sponsor's interests and obligations in the integrated structure. A Sponsorship Board was created to continue the hospital's Catholic tradition, including maintaining its chaplaincy, chapels, religious symbols, and special funds. The Sponsorship Board views the new environment as a special challenge. Its members know that Catholic sponsorship: Comforts patients, who realize they are in the hands of people motivated by the Christian ethic Creates an atmosphere in which patients and their families can seek the spiritual support that often aids healing Strengthens a sense of community among physicians, hospital staff, and administrators The Sponsorship Board hopes the sponsor's influence may come to affect the whole Mayo Medical Center, bringing patients, family members, and staff an "added dimension" of care.     

Prepuce restoration seekers: Psychiatric aspects

A new subgroup of patients within the homosexual community has been identified who are characterized by preoccupation with their absent foreskins. They associate their circumcised status with a sense of incompleteness, anger over a lack of choice, and their sense of masculinity. Four patients who sought surgical reconstruction are reported. None were Jewish or psychotic. All tolerated surgery well. Preliminary etiologic hypotheses are advanced, emphasizing psychodynamic and imprinting possibilities.     

Leadership in diversity

As principal change agents, healthcare leaders are well positioned to integrate diversity into their institutions' organizational structure. Thus healthcare leaders must be competent in handling diversity issues. Diversity refers to any characteristic that helps shape a person's attitudes, behaviors, perspective, and interpretation of what is "normal." In the healthcare ministry, diversity encompasses the cultural differences that can be found across functions or among organizations when they merge or partner. Managers and supervisors will have to be familiar with the nuances of diversity if they are to be effective. Those managers who are not adept at incorporating diversity into human resource management may incorrectly evaluate subordinates' capabilities and provide inappropriate training or supervision. As a result, some employees may be underutilized. Others may resist needed direction, overlook instructions, or hide problems such as a language barrier. If executives, marketers, and strategic planners are to develop relevant healthcare services that take into account the needs of their constituencies, they will need to determine how different groups understand and access healthcare. Healthcare leaders who know how to uncover cultural dynamics and challenge cultural assumptions will go far in enabling their staff and managers to confront personal attitudes about community residents. Ultimately, quality of service delivery will be improved.     

The new hospital CEO: many paths to the top

A new kind of hospital CEO is beginning to emerge--one who has superior qualifications in a number of areas, including financial, operational, and interpersonal skills. As the position continues to evolve, its candidate requirements are shifting. The "traditional" hospital CEO, who advanced through mainly operations positions, is still in high demand and considered by many to be well prepared to meet current hospital challenges. But the emergence of chief executives from "alternative" backgrounds signals a new diversification in the field. We surveyed 556 hospital CEOs throughout the United States to get their views on selection, and we spoke with experts and leaders in the field with broadly divergent views. Who's on the inside track? The answers may surprise you.     

Whose side are you on? Interdependence and its consequences in management of healthcare delivery

Healthcare employees who are committed to the organization and go the extra mile are especially needed today. An empirical study of visiting nurse agency employees showed that a sense of being "in the same boat" with management, or perceiving outcome interdependence, contributed to positive behaviors. Supervisors were generally more inclined than were their subordinates to perceive this interdependence, to be committed, and to exhibit good citizenship behavior. Unexpectedly, physical therapists who worked as hourly part-time contractors reported even stronger feelings of being in the same boat with management and being more committed than the supervisors. Such a sense of partnership could have been a result of the therapists' long-term relationship with the agency over an indefinite time. They might have also felt that they worked voluntarily and autonomously, rather than under close supervision. These findings point to various management actions that can engender a feeling of interdependence, pride in the organization, and fairness of treatment. One step is to involve employees in joint goal setting, organized around "our problems," not just the person's own concerns. Authentic downward communication and the sharing of operating results can convey to employees the major issues that challenge the organization. Such information makes it possible for employees to provide vital input, if not actually take on more decisions themselves. Executives can expect less commitment and less inclination from employees to go above and beyond what is expected if they fail to acknowledge good performance and if they accentuate differences between the most-senior leaders and lower-level employees.     

Contradictions of support and self-help: views from providers of community health and social services to families with young children

Providers of community health and social services to families with young children are aware of increasing poverty in particular localities and amongst particular social groups. They are also aware that their own sphere of influence which they could previously activate on behalf of their clients is diminishing. Community midwives, health visitors, social service workers and workers in voluntary sector organizations in two areas of Greater Manchester were asked about the needs of young children and their carers and their own role in fulfilling some of those needs. They located the difficulties facing their clients in both the structural constraints of poverty and in individual histories and capabilities. In so doing they construct a model of how social welfare is managed personally which has implications for the way in which they understand their own role as providers of health and social services. The study on which this paper is based was concerned with the role of 'social support’ in the lives of families deemed to be ‘in need’, from the perspective of workers. The study shows that while service providers understand and emphasize the value and importance of certain types of support in the lives of their clients, time restrictions and a delimitation of their role lead them, in certain contexts, to devalue their role in providing such support. At the same time, in order to make sense of, and give meaning to, the limits of the support they feel able to provide, they draw on notions of self-help and dependency arguing that, ideally, people should not rely on formal service provision for their support needs.     

Increasing the relevance of research to health care managers: hospital CEO imperatives for improving quality and lowering costs

BACKGROUND: Evidence-based management assumes that available research evidence is consistent with the problems and decision-making conditions faced by those who will utilize this evidence in practice. PURPOSE: This article attempts to identify how hospital leaders view key determinants of hospital quality and costs, as well as the fundamental ways these leaders "think" about solutions to quality and cost issues in their organizations. The objective of this analysis is to better inform the research agenda and approaches pursued by health services research so that this research reflects the "realities" of practice in hospitals. METHODS: We conducted a series of semistructured interviews with a convenience sample of eight hospital and three health system leaders. Questions focused on current and future challenges facing hospitals as they relate to hospital quality, costs, and efficiency, and potential solutions to those challenges. FINDINGS: Nine major organizational and managerial factors emerged from the interviews, including staffing, evidence-based practice, information technology, data availability and benchmarking, and leadership. Hospital leaders tend to think about these factors systemically and consider process-related factors as the important drivers of cost and quality. PRACTICE IMPLICATIONS: The results suggest a need to expand the methods utilized by health services researchers to make their research more relevant to health care managers. Expanding research methods to reflect the systemic way that managers view the challenges and solutions facing their organizations may enhance the application of research findings into management practice. Finally, better communication is needed between the research and practice communities. Researchers must learn to think more like managers if their research is to be relevant, and managers must learn to more effectively communicate their issues with the research community and frame their problems in researchable terms.     

Identification of community leadership in the development of public health education programs

This paper deals with the identification of community leadership within the context of a community cancer prevention education program. An unusually high age-adjusted black/white mortality ratio exists for cervical cancer in Forsyth County, North Carolina. In response to this problem, a comprehensive public education program dealing with cervical cancer prevention was developed and currently is being implemented. Black community leaders have played an important role in planning for the program and in providing assistance for program implementation. Leaders were identified by means of a modified snowball technique in which ten recognized leaders in the black community initially were contacted and asked to name at least five other leaders in areas of leadership that included social/civic, political, religious, business, and less visible leaders. This process continued until no new names were generated. Interviews were conducted with 103 persons, and 589 leaders were identified. A cohort of 54 top-ranked leaders were identified, and the characteristics of these leaders are presented. The value of the leadership identification process is discussed in terms of (a) the identification process itself, (b) the generation of a list of key individuals who can serve as sources of advice for development and implementation of the program and as the beginning point for dissemination of new information on the project, and (c) a mechanism for development of a sense of community ownership of the project.Robert Michielutte, PhD is Research Associate Professor Department of Family and Community Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 27103; Pheon Beal, MPH is Direct Education Coordinator, Forsyth County Cervical Cancer Prevention Project, Department of Family and Community Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 27103.This research was supported by contract No. NCI-N01-CN-65034 from the National Cancer Institute.     

公立医院公益性回归之文化建设

公立医院具有其自身的社会功能与社会责任,它是提高卫生服务公平性的主力军.先进的医院文化对提升医院的服务水平、构建和谐的医患关系、促进良好的社会效益具有重要意义,它能够形成群体意识,提高管理水平和服务质量,使公立医院更好地为患者服务.     

Medical opinion leaders conflict of interests: effects of disclosures on the trust of the public and general practitioners

BackgroundKey medical opinion leaders influence the behaviors of physicians and patients. By law, they have to disclose their interests with pharmaceutical companies when they communicate in the media. Up to now, it appears that no study has explored the effect of opinion leaders’ disclosures despite their potential impact on public health and economy. The study objective was to assess the effects of opinion leaders’ disclosures of interest on the public and general practitioners’ trust in opinion leader by comparison with the overall medical community.MethodsIn an experimental setting, three opinion leader profiles were built that differed only by the disclosure of their interests (hidden vs. weak vs. strong interests). One of the three profiles was randomly assigned to the subjects of two groups: 67 students and 60 general practitioners. According to an Anova analysis, the main effects and interactions of the disclosure of interests, of the message recipients, and of the assessed targets on the level of trust were measured.ResultsThe results show that the average level of trust expressed by general practitioners was lower than that expressed by the general public. The level of trust in the opinion leader was lower than that of the overall medical community. The level of trust of exposed subjects fell much lower with stronger disclosed interests. While the general public did not distinguish trust between opinion leaders and the overall medical community, practitioners showed a significantly lower level of trust in opinion leaders with increasingly strong levels of disclosed interests.ConclusionThese study results refute the assertion that public trust would be reduced by the disclosure of interests. They reinforce the importance of the “who judges who” and “which kind of disclosure impacts who ?” effects and draw attention to further research on the role of social interactions in both mass and group communications.     

上海市街道医院对实施脑卒中疾病管理的意愿分析

调查了１０９名医务人员和４１名上海市街道医院院长对脑卒中疾病管理的态度和意愿。结果发现：医务人员普遍认可预防是他们工作职责的一部分，但管理高危人群，病人和上门服务有困难。多数的医务人员认为按照标准方案开展工作欠合理（５２．３％）原因是方案限制了医务人员根据病人的情况处理疾病的自由度。     

Understanding culture: key messages for leadership

It is crucial, in an era of healthcare mergers and acquisitions, that leaders understand organizational culture and the role it plays in major transitions. Research indicates that organizational factors can lead to either the success or failure of a major change. Too many failed mergers testify to the fact that cultures sometimes collide, rather than coalesce. Culture is the human dimension of an organization. Anytime an organization makes a major change, some of its employees will experience the change as chaos. But chaos is not necessarily a bad thing. It can free people from the constraints of the past, enabling them to create new structures. But, for this to happen, leaders must help employees separate essential from peripheral matters and specify their common values and beliefs. Good leaders are vital for change as significant as an acquisition or a merger. They may want to begin with assessments of their respective cultures. They will certainly give employees an opportunity to express their sense of loss. As early in the process as possible, they should create communications mechanisms that involve employees in the change process and share vision and values. And leaders should share themselves, both their strength and vulnerability, so that employees can see change as something all are experiencing together.     

Seeing Community Benefit broadly. Everybody wins when hospitals collaborate with others to serve their communities

Community benefit is an opportunity for hospitals and health systems to affirm their community-focused missions and to ensure implementation of those missions in their organizations. There are four key themes of community benefit: community health improvement, underserved populations and unmet needs, collaboration outside the hospital, and coordination and strategic management inside the hospital. Together, these constitute a broader perspective, one in which community benefit is of strategic value to both the community and the hospital, and serves as a departure point for some of the hospital's most fruitful contributions to health and well-being. The community benefit function can be organized and managed to achieve specific priorities with measurable objectives, just like any other hospital activity. There are innumerable examples of creative and successful models for community benefit programs that incorporate the principles of community health improvement, unmet needs, collaboration externally, and strategic management internally. These are models that hospital leaders should create and pursue, because they demonstrate the value of a broad view of community benefit that fully realizes the potential of hospitals' charitable purpose.     

Community input valuable asset for hospital board

How can a hospital--looking at the future--learn what its community needs are and satisfy them? The answer lies in input from community resources beyond members of the hospital's board. Adrienne Nyman Miller offers guidelines for hospital administrators who want to incorporate those community leaders in their strategic planning process.