The health care manager's role in promoting change

In change theory the support of an institution's top management is necessary in order for planned change to be successful. However, there are many forces inhibiting administrators from providing this support. Three options are available to resolve this dilemma.

Status of infection surveillance and control programs in the United States, 1992-1996. Association for Professionals in Infection Control and Epidemiology, Inc

BACKGROUND

Nosocomial infections have been recognized as a source of morbidity and mortality throughout the world for several decades. In the United States, an estimated 2.1 million nosocomial infections occur annually in acute care hospitals alone. Infection surveillance and control programs (ISCPs) play a vital role in addressing this problem, but no national studies have described the status and composition of these programs since the 1970s.

METHODS

In January 1997, a voluntary survey was sent by mail to members of the Association for Professionals in Infection Control and Epidemiology, Inc. Only one response per facility was requested. The survey asked for information for the years 1992 to 1996 (study period), and questions pertained to characteristics of the health care facility in which the respondent worked, characteristics of the ISCP and its personnel, and the overall level of administration support for infection control activities.

RESULTS

Completed questionnaires were received from personnel at 187 health care facilities located in 40 states and the District of Columbia. The majority (76.5%) of responding facilities were nongovernment owned, and 57.2% were classified as general acute care facilities. The number of licensed beds at these facilities remained stable throughout the study period, but all other measures of facility size and activity (eg, number of patient days and number of nurses) decreased by as much as 28.9%. In 1992, ISCPs were most likely to be organizationally located in the Nursing Department, but by 1996, many had been transferred to departments of Medical Records, Quality Assurance, or Risk Management. Throughout the course of the study period, the number of facilities performing surveillance for health care-associated infections in outpatient settings increased by 44.0%, from 100 to 144. In 1996, only 47.6% of facilities had a hospital epidemiologist (HE), and HEs devoted a median of 15% or less of their time to infection control activities. For the most part, HEs were trained in infectious diseases, and few had certification in infection control. Infection control professionals (ICPs) were much more common than were HEs (ICPs were reported at 97.9% of respondents' facilities in 1996), and they spent the majority (80% in 1996) of their time on infection control activities. During the course of the study period, increasing numbers of facilities had ICPs who had certification in infection control. Furthermore, most respondents did not report a change over time in the level of administration support for infection control activities.

CONCLUSIONS

Health care delivery has changed dramatically during the past 20 years. This study presents an updated description of ISCPs in the United States. Our results illustrate several changing parameters, such as departmental shifts and increased outpatient surveillance, that reflect adjustments in health care priorities during the study period. As the transformation of the health care system continues, continued evaluation of the status of ISCPs on a national level will be necessary. Diligent monitoring, proactive measures, and collaboration between infection control organizations and government agencies will be vital for the prevention and control of health care-associated infections in the future.

The Minnesota model of subacute care

HealthPartners, a nonprofit managed care organization in Minneapolis, Minn., has developed an integrated system of care for seniors in clinics, hospitals, and subacute care centers. The organization contracts for subacute care with a few skilled nursing facilities distributed throughout the area. Concentration of patients in these facilities allows for the presence of a nurse-practitioner on site. The nurse-practitioner collaborates with a geriatrician to provide care for 15 to 20 seniors. This team uses principles of geriatric assessment to optimize utilization and outcomes for frail seniors.

The Life Care Center of St. Louis experience with subacute care

The Life Care Center of St. Louis is a 100-bed, freestanding, subacute care facility. The major differences between subacute care facilities and nursing homes are described. The problems associated with dealing with medically complex conditions in a subacute care facility are stressed. The center's approach to rehabilitation is reviewed in detail. The utility of the Functional Independence Measure in subacute care settings is discussed. Common conditions seen in subacute care facilities are briefly reviewed.

The business of perioperative medicine

Medical centers should insist that their top officials have a firm grasp of contemporary business principles, use that skill set, and run the medical business like any other. This business imperative does not exclude a conscious decision to measure success by the amount of articles published or charity care given rather than the amount of profits. Physician leaders should insist that while they care for patients, someone cares for the business.

Management challenges faced by managers of New Zealand long-term care facilities

This article reports on a postal survey of 78 long-term care managers in one region of New Zealand, of whom 45 (58%) responded. Most long-term care managers (73.2%) were middle-aged females holding nursing but not management qualifications. Most long-term care facilities (69%) tended to be stand-alone facilities providing a single type of care (rest home or continuing care hospital). The most prominent issues facing managers were considered to be inadequate funding to match the growing costs of providing long-term care and occupancy levels. Managers believed that political/regulatory, economic and social factors influenced these issues. Despite a turbulent health care environment and the challenges facing managers, long-term care managers reported they were coping well and valued networking.

Assessment of infectious disease surveillance--Uganda, 2000

In 1998, member states of the African region of the World Health Organization (WHO-AFRO) adopted the integrated disease surveillance (IDS) strategy to strengthen national infectious disease surveillance systems (1). The first step of the IDS strategy is to assess infectious disease surveillance systems. This report describes the results of the assessment of these systems of the Uganda Ministry of Health (UMoH) and indicates that additional efforts are needed to develop the basic elements of an effective surveillance system.

Organizational status of quality assurance and end-user perceptions of information technology for information management

This article investigates the relationship between quality assurance (QA) and perceptions of the importance of information technology (IT) for information management in the health care industry. This issue is important because effective information management is recognized as a necessary condition for quality management. The unit of analysis of the article is the health care functional department. Data from 34 health care departments were collected and used for the analysis. Four specific hypotheses were proposed and tested. Our results suggest that end-user perceptions of the importance of IT for information management depends on formalization of QA, perceived importance of QA, time since QA was embraced, and number of people in the QA function.

A multi-level performance appraisal tool: transition from the traditional to a CQI approach

The commitment of many health care organizations to CQI calls for the introduction of tools, principles, and procedures to ensure that the performance improvement in all parts of the organization is initiated. In order to determine whether the desired performance standards are indeed being achieved on all organizational levels, it is necessary to apply a holistic performance appraisal tool that would allow for an assessment of the company's progress from multiple dimensions. This article details the design of the multilevel appraisal model, explicates where the evaluation errors may occur, and presents managerial implications for successful implementation of this evaluation tool.

Front-line training: a health care imperative

Training departments in health care institutions are faced with the problem of providing increased services despite reduced budgets. The increased educational needs are the result of organizational reengineering, mergers and acquisitions, technical advances, and the increasing reliance on less qualified employees. One solution to this dilemma is to make better use of managers and experienced workers as trainers. Keys to success include the ability to convince managers that they will benefit from their expanded roles, and to motivate workers to share their knowledge and skill with their team-mates in a cross-training endeavor.

The challenge of disseminating innovations to direct care providers in health care organizations

Innovation is the discipline of applying new knowledge gained from multiple sources, including, but not limited to, scientific research. What is known and believed about knowledge generation, sharing, and dissemination of innovative ideas is discussed, with emphasis on applications to nursing and health care. The US Department of Veterans Affairs' virtual learning center is an example of a technology-based center that provides the opportunity to nurture social learning. Expanding the understanding of the generation and spread of innovations, and applying this knowledge in health care settings are critical to rapid changes in our social systems.