[Opinions on the organisation of health care in strokes. A survey among hospital medical directors in Spain]

INTRODUCTION

Therapy to treat strokes has changed dramatically. Around 70 years ago, it could not be treated and today it is a medical emergency. Awareness of this change has still not reached many layers of the medical or health care professions or of society itself.

AIM

To use a survey to evaluate the attitudes of medical directors and hospital specialists towards the problems involved in the inpatient care of stroke patients. Materials and methods. A survey was carried out by means of a pilot study in hospitals in Madrid with specific sub-surveys for medical managers in charge of neurology departments, neurosurgery services and stroke units. These surveys were sent out to 108 acute care hospitals with over 250 beds in 2003-2004.

RESULTS

Only the results of the survey administered by medical directors are analysed. Finally, 52 surveys were obtained from 108 hospitals. Information was collected about several aspects of stroke patients, including care in hospital emergency department, admission to hospital, rehabilitation treatment and staffing in stroke units. Care of stroke patients was given a significantly more positive score (better stroke care) by medical directors than by hospital neurologists.

CONCLUSIONS

The survey revealed a great care burden from stroke in hospital emergency departments and from hospital admissions, deficits in neurological duty services and in the capacity to perform fibrinolysis and, above all, in stroke units. The data obtained show that medical directors should improve their attitudes with regard to the care of stroke patients.

Injury data in British Columbia: policy maker perspectives on knowledge transfer

Provincial and regional decision makers in the injury prevention field were interviewed in British Columbia (B.C.) to obtain their views about best processes for the transfer or dissemination of relevant data. These decision makers (n = 13) indicated that data should provide them with a holistic and comprehensive picture to support their decision processes. In addition, they felt information about injury types and rates should be linked backward to determinants or causes and forward to consequences or outcomes. This complete chain of data is needed for planning and evaluating health promotion interventions. It was also felt that data providers needed to devote more effort to fostering effective receptor capacity, so that injury prevention professionals will be better able to understand, interpret and apply the data. These findings can likely be generalized to other jurisdictions and policy areas, and offer additional insight into the practicalities of knowledge transfer and exchange in researcher/decision maker partnerships.

Qualities that foster cohesive teams

The radiology manager can be influential in promoting group cohesiveness within the department. Identifying qualities that radiology managers believe to be descriptive of cohesive work teams could be very informative for other radiology managers. The surveyed radiology managers had a positive perception of their work groups based on the factors that promote cohesion and achievement. The survey instrument developed has high internal correlation for future use with other radiology managers and employee groups. Continued research is needed to determine if these group results are indicative of the larger field of radiology management

Quality monitoring and management in commercial health plans

OBJECTIVE

To examine the current state of quality monitoring and management activities of US health plans.

STUDY DESIGN

Cross-sectional survey.

METHODS

We surveyed medical directors of 252 commercial HMOs (96% response rate) drawn from 41 nationally representative markets in the United States. We randomly sampled healthcare markets with at least 100,000 HMO enrollees. The markets in our sampling frame include an estimated 91% of US HMO enrollees and represent 78% of the metropolitan population.

RESULTS

There was near-universal collection of data at the health plan level for each of the 7 outpatient measures we examined (ranging from 92.1% of health plans that collect data on hypertension control and cholesterol management (see p. 379) to 99.2% that collect data on patient satisfaction). There also was substantial data collection at the level of the individual provider or physician group (ranging from 50.4% for hypertension control to 81.4% for diabetes care); this was more common in health plans that primarily use capitation to reimburse primary care physicians. Health plans that collected data typically fed these data back to physician groups, but public reporting to enrollees was infrequent.

CONCLUSIONS

Almost all health plans measured their performance on multiple indicators of quality. The majority of health plans also collected data at the level of the individual physician or group and used these data in quality improvement activities, but not in public reporting. Thus, adoption of physician-level performance measurement and reporting by the Centers for Medicare & Medicaid Services will likely entail a major change for individual physicians.

Vertical versus lateral thinking

Traditional medical training may actually impede a physician's ability to solve complex problems because it is based on vertical, linear and traditional thinking.

Doctors say future of price transparency appears cloudy

A new ACPE survey on price transparency reveals that, while physician executives recognize the trend, they're not convinced that health care pricing can be easily understood by patients.

Current issues facing academic surgery departments: stakeholders' views

PURPOSE

To determine the issues important to stakeholders in today's academic surgery departments, to query key stakeholders about possible solutions, and to investigate the correlation of organizational alignment among department stakeholders with department performance.

METHOD

Between July 2003 and October 2005, the author designed, piloted and carried out a study in which he interviewed key stakeholders-deans, chief executive officers/chief financial officers (CEOs/CFOs) of hospitals and health system practice plans, surgery department chairs, and surgery department members-from 12 randomly selected academic surgery departments. Important issues and solutions were identified and comparisons among stakeholder groups performed. Alignment was evaluated both among and within groups and organizations.

RESULTS

Stakeholders (11 deans, 9 CEO/CFOs, 12 department chairs, 10 department faculty members) identified 12 issues and offered potential solutions and responses important to today's academic surgery department. One issue identified was promotion and tenure; nearly all stakeholders stated that its current form needed to be changed. Alignment analysis was incomplete because of inconsistent outcomes reporting.

CONCLUSIONS

The uniformity of issues facing academic surgery departments and the similarity of the solutions proposed to address these issues (both study findings) suggest a need to change the paradigm and think "outside the box." The study findings suggest that academic surgery departments, under strong leaders, must establish a unified culture, define a compelling vision, articulate a clear mission, and develop fully accepted values to be successful. The study findings could be useful in designing and developing academic surgery departments in today's health care environment.

Multisource feedback: 360-degree assessment of professional skills of clinical directors

For measuring behaviour of National Health Service (NHS) staff, 360-degree assessment is a valuable tool. The important role of a clinical director as a medical leader is increasingly recognized, and attributes of a good clinical director can be defined. Set against these attributes, a 360-degree assessment tool has been designed. The job description for clinical directors has been used to develop a questionnaire sent to senior hospital staff. The views of staff within the hospital are similar irrespective of gender, post held or length of time in post. Analysis has shown that three independent factors can be distilled, namely operational management, interpersonal skills and creative/strategic thinking. A simple validated questionnaire has been developed and successfully introduced for the 360-degree assessment of clinical directors.

Public health decision-makers' informational needs and preferences for receiving research evidence

OBJECTIVES

The purpose of this study was to identify decision-makers' preferences for the transfer and exchange of research knowledge. This article is focused on how the participants define evidence-based decision-making and their preferences for receiving research evidence to integrate into the decision-making process.

METHODS

Semistructured interviews were conducted with a purposive sample of 16 Ontario public health decision-makers from six Ontario public health units in this fundamental qualitative descriptive study. The sample included nine program managers, six directors, and one Medical Officer of Health. Participants were asked to define the term evidence-based decision-making and identify preferred research dissemination strategies. The interviews were audio-taped, transcribed verbatim, and coded for emerging concepts.

RESULTS

Participants defined evidence-based decision-making as a process whereby multiple sources of information were consulted before making a decision concerning the provision of services. To facilitate integration of research evidence into the decision-making process, public health administrators appreciate receiving, in both electronic and hard copy, systematic reviews, executive summaries of research, and clear statements of implications for practice from health service researchers.

CONCLUSIONS

Although consensus exists among participants concerning the definition of evidence based public health decision-making, ongoing efforts are required to continue to promote the use of research evidence in program planning and public health policy. It is also important to continue to improve the ease with which public health decision-makers access systematic reviews, as well as to ensure the relevance and applicability of the results to the practice setting.

Ambulatory care visits and physician satisfaction: from medical directors' perspectives

BACKGROUND

Under the universal health insurance system in Taiwan, policy makers seek new approaches to balance rising costs and quality of care. One policy, Ambulatory Care Reimbursement, enacted in 2001 has effectively reduced patient numbers in clinics by cutting per patient reimbursement when a physician has seen over predetermined number of patients.

PURPOSE

To access the impact of this policy on physician satisfaction in regional hospitals and medical centers (MCs) from the point of view of their medical directors.

METHODOLOGY

We conducted a cross-sectional survey of medical directors from 25 MCs and 78 regional hospitals in Taiwan. The survey used a 5-point Likert scale to identify both impacts of reduced ambulatory care visits and physician satisfaction. We randomly selected 30% of all medical directors from both types of medical institutions. Of the 248 medical directors contacted, 142 replied. Excluding 5 incomplete responses, our final sample was 137. Response rates were roughly equivalent for MCs (54.67%) and regional hospitals (57.89%).

FINDINGS

Medical directors were typically male, aged 45.11 years, worked in MCs (60%), and were general practitioners (43.1%). Multiple regressions associated three independent predictors of physician satisfaction: physician-patient interaction (beta = .393, p = .001), mission (beta = .351, p = .007), and reduced health care expenditures (beta = .179, p = .014). Medical directors more often characterized the regulation of reducing number of visits as a means of encouraging MCs and regional hospitals to improve physician interaction with patients and, thus, associated it with greater patient satisfaction. Generally, directors did not believe that the regulation encouraged patients seeking care at other hospitals or that it resulted in reduced pay to physicians.

PRACTICE IMPLICATION

Reducing ambulatory care visits has promoted the physician-patient relationship and allowed many physicians attain their medical mission. Such regulation had influence on the physicians' satisfaction.