The psychology of organizational structure in integrated health systems

Examine a social learning theory model as a framework to guide health system leaders as they consider the psychology of organizational design as it pertains to the successful integration.

The role of organizational affiliations and research networks in the diffusion of breast cancer treatment innovation

INTRODUCTION

The National Institutes of Health (NIH) sees provider-based research networks and other organizational linkages between academic researchers and community practitioners as promising vehicles for accelerating the translation of research into practice. This study examines whether organizational research affiliations and teaching affiliations are associated with accelerated diffusion of sentinel lymph node biopsy (SLNB), an innovation in the treatment of early-stage breast cancer.

METHODS

Surveillance Epidemiology and End Results-Medicare data were used to examine the diffusion of SLNB for treatment of early-stage breast cancer among women aged 65 years and older diagnosed between 2000 and 2002, shortly after Medicare approved and began reimbursing for the procedure.

RESULTS

In this population, patients treated at an organization affiliated with a research network--the American College of Surgeons Oncology Group (ACOSOG) or other National Cancer Institute (NCI) cooperative groups--were more likely to receive the innovative treatment (SLNB) than patients treated at unaffiliated organizations (odds ratio: 2.70, 95% confidence interval: 1.77-4.12; odds ratio: 1.84, 95% confidence interval: 1.26-2.69, respectively). Neither hospital teaching status nor surgical volume was significantly associated with differences in SLNB use.

DISCUSSION

Patients who receive cancer treatment at organizations affiliated with cancer research networks have an enhanced probability of receiving SLNB, an innovative procedure that offers the promise of improved patient outcomes. Study findings support the NIH Roadmap and programs such as the NCI's Community Clinical Oncology Program, as they seek to accelerate the translation of research into practice by simultaneously accelerating and broadening cancer research in the community.

Physician preferences for accredited online continuing medical education

INTRODUCTION

The need for up-to-date and high-quality continuing medical education (CME) is growing while the financial investment in CME is shrinking. Despite online technology's potential to efficiently deliver electronic CME (eCME) to large numbers of users, it has not yet displaced traditional CME. The purpose of this study was to explore what health care providers want in eCME and how they want to use it.

METHODS

This was a qualitative study. Two 3-hour focus groups were held with physicians in both academic and community practices as well as trainees knowledgeable in the hypertension clinical practice guidelines with a willingness to discuss eCME. Content/thematic analysis was used to examine the data.

RESULTS

Three main themes emerged: credibility, content/context, and control. Credibility was the most consistent and dominant theme. Affiliations with medical organizations and accreditation were suggested as methods by which eCME can gain credibility. The content and need for discussion of the content emerged as a key pivot point between eCME and traditional CME: a greater need for discussion was linked to a preference for traditional face-to-face CME. Control over the content and how it was accessed was an emergent theme, giving learners the ability to control the depth of learning and the time spent. They valued the ability to quickly find information that was in a format (podcast, video, mobile device) that best suited their learning needs or preferences at the time.

DISCUSSION

This study provides insight into physician preferences for eCME and hypotheses that can be used to guide further research.

Turnkey offering a claimed sector 'first'

Manufacturer and supplier of LED theatre lights, HD camera systems, video integration technologies, and ceiling support units, Trumpf Medical Systems UK, and "logistical services" company Canute International Medical Services (CIMS), one of whose specialities is providing mobile medical units for diagnostic imaging, have entered into a partnership that will see the two companies offer fully fitted out modular operating theatres and other medical/clinical buildings incorporating the latest technology and equipment, on a fully project-managed, "turnkey" basis. Oliver Law, Trumpf Medical Systems UK managing director, explains the background, and the new service's anticipated customer benefits.

Status, equity and social identification during an intergroup merger: A longitudinal study

Using an intergroup perspective, this longitudinal study (N=215) examined the adjustment patterns of employees from low vs. high status pre-merger organizations. The first questionnaire was distributed 3 months after the implementation of the merger, whereas the second was completed 2 years later. As predicted, members of the low status group perceived the merger to be implemented in a less fair manner at the start of the merger and reported a decreased adjustment to the merger over time. Members of the high status group showed an increase in adjustment over time, lower in-group bias and a stronger identification with the new merged organization. Path analyses further confirmed that identification with the new merged organization mediated the associations between perceptions of fairness and in-group bias as well as changes in adjustment over time. With its longitudinal design, this study replicates and extends past results by revealing the predictors of adjustment for members of low vs. high status groups involved in an intergroup merger.

Notation of professional qualifications and affiliations: avoiding puffery and deception

Neuropsychologists are ethically charged with communicating their qualifications and credentials in ways that promote understanding and avoid deception. However, there exist few if any concrete guidelines about how and when to cite qualifications when rendering professional neuropsychological opinions. This article attempts to clarify the issues relevant to the signatory process, offering guidelines based on principles of accuracy, relevancy, and necessity. Common practices and problems are outlined, and recommended solutions offered.

Guidelines needed for academic titles within dermatology

The system of giving academic titles to those outside of full-time academic practice should be re-evaluated.

Challenges of multisite surgical teaching programs: a review of surgery clerkship

OBJECTIVE

As the enrollment in medical schools increases, the need for affiliated sites to participate in clerkship teaching will continue. The aim of this literature review was to provide a summary of measures that have been used to compare the training in affiliated community hospital sites with the tertiary teaching hospitals.

METHODS

An extensive literature search was conducted using PubMed, MEDLINE, and EMBASE. A total of 386 articles were identified, of which 20 were found to be relevant to this topic. The references of those articles were also consulted and were included in the preparation of this manuscript when deemed appropriate.

RESULTS

A significant difference does not seem to exist in either written examination or clinical performance evaluations among medical students who receive training at either tertiary care teaching hospitals or affiliated community hospital sites. Positive role models are important in influencing the choice of a surgical career, regardless of where clerkship training takes place.

CONCLUSIONS

Although more research is merited in this area, the current evidence suggests that affiliated sites are comparable in their ability to train medical students during their surgical clerkship.

College/school of pharmacy affiliation and community pharmacies' involvement in public health activities

OBJECTIVES

To examine the relationship between pharmacy college/school affiliation and community pharmacies' involvement in immunization and emergency preparedness activities.

METHODS

Telephone interviews were completed with 1,704 community pharmacies randomly sampled from 17 states to determine the pharmacies' involvement in immunization promotion, vaccine distribution, in-house immunization delivery, and health emergency preparedness and response, affiliation with college/school of pharmacy, and selected pharmacy and public health-related characteristics.

RESULTS

Pharmacy college/school-affiliated community pharmacies were more likely than non-affiliated pharmacies to participate in immunization and emergency preparedness when controlling for pharmacy characteristics. College/school affiliation generally became nonsignificant, however, when public health-related characteristics were included in the analysis.

CONCLUSIONS

Affiliation with a college/school of pharmacy was related to community pharmacies' involvement in immunization and emergency preparedness.

Life after near death

St. Anthony Hospital in Chicago has split from Ascension Health, determined to go it alone while the overall trend is to seek shelter in large systems. One strategy St. Anthony is employing is forging a greater connection with its community. Staying with Ascension made little sense, officials say. "It's not the kind of hospital that you would typically associate with Ascension in a given state," says hospital Chairman Peter Fazio, right.

Moving towards integrated working in health and social care in Scotland: from maze to matrix

The development of integrated working across health and social care has featured strongly in recent policy directives in both England and Scotland. This is part of a wider agenda of partnership and collaboration, with a range of options from the creation of unified structures as in the care trusts in England to localised arrangements for joint working between individual professionals. This article presents a detailed matrix of drivers and barriers to integrated working which has been developed through a number of case studies of community care practice pursued as part of work undertaken for the Joint Future Group of the Scottish Executive. Drivers and barriers in three key areas are highlighted: national policy frameworks, the local planning context, and operational factors. It is anticipated that the matrix should provide a useful framework for the detailed scrutiny and operationalisation of integrated working.

Making the right decisions in a consolidating market

Market forces may lead to increased consolidation in the healthcare industry, creating both opportunities and challenges. Opportunities for small hospitals and health systems include partnering with stronger organizations, while for larger organizations, acquiring potentially undervalued hospitals can yield the benefits associated with increased size and scale. Potential barriers to success arise in three areas-strategy, finance, and operations. Healthcare executives must understand and be willing to fully address these challenges.

Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest

Professional medical associations (PMAs) play an essential role in defining and advancing health care standards. Their conferences, continuing medical education courses, practice guidelines, definitions of ethical norms, and public advocacy positions carry great weight with physicians and the public. Because many PMAs receive extensive funding from pharmaceutical and device companies, it is crucial that their guidelines manage both real and perceived conflict of interests. Any threat to the integrity of PMAs must be thoroughly and effectively resolved. Current PMA policies, however, are not uniform and often lack stringency. To address this situation, the authors first identified and analyzed conflicts of interest that may affect the activities, leadership, and members of PMAs. The authors then went on to formulate guidelines, both short-term and long-term, to prevent the appearance or reality of undue industry influence. The recommendations are rigorous and would require many PMAs to transform their mode of operation and perhaps, to forgo valuable activities. To maintain integrity, sacrifice may be required. Nevertheless, these changes are in the best interest of the PMAs, the profession, their members, and the larger society.

The University of Cincinnati College of Medicine Department of Surgery

The University of Cincinnati College of Medicine Department of Surgery has a legacy of discovery, transformation, and education that began more than 200 years ago. Through collaborations with related disciplines at the University of Cincinnati, industry, the government and military, as well as our partners in the community, we look forward to new innovations to continue the legacy and our ongoing mission to provide the best possible surgical care, research, and education of our future surgeon leaders. Our mission remains: 1) To provide comprehensive surgical services for Cincinnati and the surrounding region; 2) To train the next generation of surgeon leaders; 3) To advance the state-of-the-art and scientific basis of the discipline of surgery; and 4) To provide leadership in ensuring surgical health care for all members of the Cincinnati community. These principles have always been part of our legacy and ongoing challenges as an academic department of surgery. It is a proud tradition that we embrace and will carry into the future.

Defining the role of University of Kentucky HealthCare in its medical market--how strategic planning creates the intersection of good public policy and good business practices

In response both to national pressures to reduce costs and improve health care access and outcomes and to local pressures to become a top-20 public research university, the University of Kentucky moved toward an integrated clinical enterprise, UK HealthCare, to create a common vision, shared goals, and an effective decision-making process. The leadership formed the vision and then embarked on a comprehensive and coordinated planning process that addressed financial, clinical, academic, and operational issues. The authors describe in depth the strategic planning process and specifically the definition of UK HealthCare's role in its medical marketplace. They began a rigorous process to assess and develop goals for the clinical programs and followed the progress of these programs through meetings driven by data and attended by the organization's senior leadership. They describe their approach to working with rural and community hospitals throughout central, eastern, and southern Kentucky to support the health care infrastructure of the state. They review the early successes of their strategic approach and describe the lessons they learned. The clinical successes have led to academic gains. The experience of UK HealthCare suggests that good business practices and good public policy are synergistic.