Sampling clinicians' activities using electronic pagers

Pager-based activity sampling (PAS) is described as a cost-effective and unobtrusive method for sampling residents' activities in clinical settings. A sample program evaluation is presented using residents in an urban children's hospital resident-training program. The purposes of the program evaluation were: (a) to establish a behavioral baseline that would help clinical faculty understand how residents were using their time, and (b) to determine whether alterations in the way residents were assigned within the hospital resulted in desired changes to time spent. The primary rationale for changing resident-assignment policies were: (a) to decrease the time residents were spending in transit between various locations within the hospital, and (b) to increase the time spent by residents in educational activities and in direct contact with patients and their families. This PAS application demonstrates that the technique can produce statistically supportable conclusions, at minimal cost, without unduly disrupting either the residents or their patients. PAS is compared with other time-sampling methods, its limitations are discussed, and suggestions for future applications are provided.     

Health planning: a vital role for district health authorities

Next April the planning function of DHAs will change. However, planning will still be vitally important if they are to perform their purchasing role effectively. Douglas Scott discusses the implication of this and describes the approach to planning being developed in Leeds.     

Harvard Pilgrim Health Care--leading the competition and growing

New England's largest HMO wants to be even bigger. The product of a 1995 merger, Harvard Pilgrim is seeking ways to reduce per-member-per-month costs, creating new health plans with greater choice of providers, changing physician relationships from staff-model to group practice and looking at other merger opportunities.     

Sentara Health System--reinventing the organization

This Norfolk, Va.-based system began a five-year effort to change the way it does business by streamlining governance and involving physicians in management. Now in its third year of "Reinventing Sentara," it's focusing on increasing covered lives and cutting costs while increasing quality; some 15 priority redesign projects were identified and half of those have been implemented.