Creating an integrated health care system: the health and human risk management model

This article critiques the current health care system and presents a new conceptual model that offers the potential for an integrated health care system in the future. Health care currently consists of parallel care systems based on the competing conceptual frameworks of the medical model and the psychosocial model. It is argued that psychosocial factors must be included in an integrated system. Research literature is reviewed that documents the need for, the therapeutic effectiveness of, and the medical cost-offset benefits of mental and behavioral health interventions. The Health and Human Risk Management Model is described and illustrated with a case example as well as research outcomes from its implementation at United HealthCare Corporation.     

新时期现代医院护理人力资源管理

护理工作是医院工作的重要组成部分，护理人力资源合理地引进、培养、配备和使用是医院护理质量的重要保证。如何对护理人力资源进行有效的管理，适应新时期医疗行业改革发展的需要，是每一位护理管理者关注的热门话题。我院自2004年实行新的人事制度后，管理人员从各个方面对全院护理人力资源进行综合管理，取得良好的效果，现将经验体会汇总如下。     

同质服务理念在手术室护理人力资源配置中的应用

目的运用同质服务理念加强手术室晚夜间、双休日的护理人员配置,以提升护理内涵,优化护理质量,使所有手术患者享受同等、同质、安全的护理服务。方法对手术室90名护士实行同质服务理念下晚夜间、双休日护理人力资源配置,调查实施同质服务前后各60例患者（主要为晚夜间及节假日进行急诊手术的患者）、72名手术医生、90名手术室护理人员对手术室护理工作的满意度。结果实施同质服务后,手术医生、患者及护理人员自身对手术室护理工作满意度分别为95.23％,93.50％,93.00％,明显高于实施前的90.70％,88.16％,92.50％,差异有统计学意义（χ2值分别为28.59,19.86,15.89;P〈0.05）。结论同质服务的实施,最大限度地发挥手术室护理人员的专科优势,充分保证了患者享受同等医疗的权利,达到了医、护、患三方共同受益。     

Supply of health care in the Australian bush: human resources and government policy

The Australian bush--the heart of Australian folklore and a fascinating attraction for tourists, whether from within Australia or other countries--does not enjoy the same attraction for professionals across a range of industries including health, where there is a chronic shortage of human resources. Whilst data vary considerably between regions, in many cases, Australians from rural and remote regions have a lower health status than the overall population. This is particularly true of the population of Indigenous origin. There are about 250 medical practitioners for 100,000 people in Australia. This number varies between about 300 in the capital cities and just over 100 in the remote areas, the latter being mostly general practitioners as there are hardly any hospitals and specialists in those remote areas. The data change across professions--for example the number of nurses is about the same in capital cities and in remote areas: about 1000 full time equivalent for 100,000 people. They change too when we consider rural regions that are less or not isolated: in some instances, these are less supplied than remote areas, where access to care however remains more critical because of distance. The demographic profile of the professions examined in this paper also vary between regions, giving more urgency to workforce planning issues. The Australian government has embarked on the delivery of a major rural health strategy aimed at increasing access to health care in the rural and remote regions--through the provision of more and better services (specialist services; multipurpose centres); attracting more health professionals (scholarships for health students; setting up of rural universities); and retaining and supporting those professionals in rural and remote areas (on-going training; support programs for families and overseas trained doctors; practice management and financial incentives).     

Ten years development of human resources in Serbian health system

A key component of any healthcare reform process is to ensure that the services are delivered by the right numbers of staff with appropriate skills and training. In 2007, public health institutions in Serbia had 2% more employees than before the economic transition. Nevertheless, the trend of the total number of employees in the Serbian health care system still preserved a mild rising trend. The most prominent changes in the structure of human resources were effectuated in the total numbers of physicians, nurses and administrative and technical staff. Development of medical science and practice in Serbia is characterized by more intensive processes of specializations, resulting in increased number of specialists among medical doctors. Health care provided in in-patient institutions still employs most of the doctors. The number of unemployed physicians, dentists and pharmacists has been rising since 2000. Another aspect that explains the rise of unemployed, university educated human resources is the rising number of graduated physicians, dentist and pharmacists. Health care policy makers may recognize the need for more integrated planning of human resources in health care, in particular, making management of human resources responsive to system needs and design, instead of vice versa.     

Reforming the Portuguese health services system: key human resources for health issues

In Portugal, for the last thirty years, there have been major developments in the human resources for health (HRH) situation, which are described as part of three waves of reforms. Portugal remains without a formal explicit and comprehensive HRH medium to long-term strategy. Consequently serious problems of scarcity, geographical misdistribution, and imbalances between levels of healthcare provision as well as in the ratios between professional groups and specialties still exist. Professional councils however have recognized the need for performance management and life-long recertification and have acknowledged the importance of an adequate skills mix and of complementarities through team work in the health sector. Professional associations have greatly contributed to the changes observed through a process of non-formal strategizing.     

The World Health Organization and the development of human resources of the health system

Health workforce is among the main components of the health care system. The performance of the latter depends on the knowledge, competence and motivations of the various categories of health workers. The task of the World Health Organization is to analyze the main problems related to health workforce and to help member-states overcome these problems. An other task is to facilitate intercountry comparisons. To attain these objectives, WHO has developed a conceptual framework, taking into account elements such as the labour market, the health care system, the policies and macro-factors (economic, socio-demographic). Among the main issues related today to health workforce, one can quote: the numbers and distribution of health workers, their migration, their involvement into the field of public health, the contents of their training, and, finally, the increased risk factors they are challenging.     

浅析ISO质量管理体系在护理人力资源管理中的运行

随着知识经济和我国医疗卫生体制改革的不断深入,越来越多的医院及医疗卫生机构认识到,人力资源作为医院的第一资源,先进、科学、规范的人力资源管理,将使医院具有持续发展的竞争实力。ISO质量管理体系已被广泛应用于护理管理中[1-6]。我院护理工作于2004年6月通过了“中国认证机构国家认可委员会对医院“护理服务过程”的质量认证。两年来,对护理人力资源管理按照ISO质量管理体系标准的要求,取得了良好的效果。现总结如下。1ISO质量管理体系标准对人力资源管理的要求组织在建立、实施和持续改进质量管理体系中,对从事影响护理质量活动…     

浅析ISO质量管理体系在护理人力资源管理中的运行

随着知识经济和我国医疗卫生体制改革的不断深入，越来越多的医院及医疗卫生机构认识到，人力资源作为医院的第一资源，先进、科学、规范的人力资源管理，将使医院具有持续发展的竞争实力。ISO质量管理体系已被广泛应用于护理管理中。我院护理工作于2004年6月通过了“中国认证机构国家认可委员会对医院“护理服务过程”的质量认证。