Reforming America's health system through innovation and entrepreneurship

America's attempts for healthcare reform are gridlocked. Healthcare special interests are reluctant to abandon profitable activities, and American culture-distrust of centralized federal power, belief in self-improvement, desire for choice, and belief in equal access to medical technologies-is slow to change. Physician entrepreneurship and innovation, coupled with consumer-driven healthcare and public-private partnerships, may break the present gridlock.

The changing nature of the measurement of the economic impact of nursing care on health care organizations

This paper adapts the perspective of organizational contingency theory to consider the changing nature of how the economic impact of nursing care upon health care organizations is measured. It is argued that useful measures of the economic impact of nursing care are a function of environmental, organizational, and technological circumstances. The increasing and diverse demands of health care consumers (environmental), the dramatic restructuring and re-engineering of the health care delivery system (organizational), and recent developments in the capabilities of and insights from information measurement practices (technological), have all provided opportunities for more meaningful measurement of the contributions of nursing care to the economic well-being of health care organizations.

"See and Treat": spreading like wildfire? A qualitative study into factors affecting its introduction and spread

OBJECTIVES

The aim of this paper was to explore key factors that influenced the spread of "See and Treat" in a range of accident and emergency (A&E) departments.

METHODS

The study adopted a qualitative approach, and semi-structured interviews were undertaken with 21 key individuals working across 10 A&E departments operating See and Treat. Participants included clinicians, managers, and chief executives.

RESULTS

Many factors influenced the spread of See and Treat. The initiative was well supported and monitored by external agencies, patients benefited and no staff groups lost out, waiting times were reduced, and Department of Health targets were achieved. However, this study indicates there were also a range of factors that limited the spread of See and Treat, including lack of additional resources and suitably experienced staff, impact upon quality of care, and no prior evaluation of its benefits. An interesting additional factor that may be both facilitating and limiting is the complexity of the A&E culture, in particular staff perspectives about working with minor injuries.

CONCLUSIONS

See and Treat was promoted as a solution to waiting times problems in A&E, without evidence from any national evaluation. However, many staff members referred to its usefulness as a tool to reduce waiting times and enhance the patient journey, although resource, quality, and staffing issues may mean such an initiative may be difficult to sustain in its present form.

Medicare reform--a wolf in sheep's clothing

This article examines the Medicare Prescription Drug, Improvement and Modernization Act of 2003 as a case study of the political process and examines the elements of the legislation, the process of passage, and implications of some its most controversial components.

Infection control: the environment and service organisation

Healthcare-associated infection is one of the major challenges to providing high quality health care. Policy makers in the United Kingdom are emphasising initiatives to increase compliance with hand hygiene protocols because most cross-infection occurs via hands. The contribution of the environment to risks of infection has received less attention, despite media reports of dirty hospitals. However, the environmental contribution may be greater than previously considered. Changes in the way health care is delivered, especially the movement of patients and staff between different hospitals and wards, may also contribute to the difficulty of controlling infection.

Making the most of research opportunities for nursing

The Department of Health (2005) consultation document Best Research for Best Health: A New National Health Service Research Strategy offers both opportunities for the future development of nursing research and threats to its future. Lessons from the history of health research reforms in the UK suggest that it will take time for any benefits to become obvious and that only some members of the research community will receive funding. In the past few years the quality, potential leadership and skills base for nursing research have shown unprecedented improvements. Combined with a professional understanding of nurses' careers in both practice and education, the proposed new strategy could work to the advantage of nurses and the patients who rely on their expertise. It is, however, essential that the experience and ambitions of as many nurses as possible now feed into this consultation process.

The utility of CPD for older adult mental health nurses

AIM

To investigate how mental health nurses working with older adults perceive the benefits and realities of developing the outcomes of current continuing professional development training into actual clinical practice.

METHOD

A structured questionnaire was used with a convenience sample of nursing staff. Qualitative analysis was performed using a grounded theory approach in order to identify emergent themes, concepts and categories of data. Four randomly selected nurses were subjected to a voluntary semistructured interview using the questionnaire as a basis for information gathering.

RESULTS

The main reason for attending courses was developing skills. Of those attending courses, 42 per cent of qualified and 35 per cent of unqualified staff had a personal development plan (PDP) or individual performance review (IPR). Significantly, all unqualified staff who had not been on a course had no PDP or IPR. Learning was described as applicable to practice by 85 per cent of unqualified and 70 per cent of qualified staff. However, 28 per cent of unqualified staff and 20 per cent of qualified staff felt their practice had not changed as a result of their learning.

CONCLUSION

CPD can be a positive experience, providing nurses with the opportunity to direct their professional development.

Empowering nurses--improving care nurses' response to the new Health Services Reform Programme in Ireland

The Health Service Reform Programme in Ireland will be the biggest change ever seen in the health service. This programme will be dependent on information structures that provide appropriate and timely information. The Nursing Informatics Project Team in the Mater Misericordiae University Hospital, Dublin is in the process of implementing an Integrated Nursing Information System, which will facilitate participation in the new reforms.

Confronting Africa's health crisis: more of the same will not be enough

The international community needs to rethink its approach to Africa if it wants to produce sustained improvements in health

The Wolverhampton Prolific and Other Priority Offenders' Programme

This article considers the increasing involvement of the criminal justice system within substance misuse treatment services, through the example of the Prolific and Other Priority Offenders' treatment programme. It outlines some of the inherent potential professional conflicts that this generates and how these have been overcome, at the local level, to progress multi-agency working with the criminal justice system. The article is written as a descriptive presentation of good practice, with the intention of reassuring other treatment professionals that if the necessary changes are managed appropriately, professional obligations can be maintained, with the resulting service development benefiting both the clients and the community as a whole. Although the article is written from a nursing perspective, it is equally applicable to other health and social care professionals working within substance misuse treatment.

Transferable learning from international primary care developments

Alternative approaches to the comparative analysis of international health systems developments are reviewed in relation to the advent of new primary care organizations in countries with parallel 'modernizing' policies. A framework for transferable learning between these is articulated and its design described. This is derived from priorities defined by lead policy and practice representatives in UK primary care. It points to the benefits of examining the interaction of critical new public management and planning functions as an effective vehicle for identifying both individual country role models and shared international experiences. Illustrative examples are provided in five subject areas ranging from local engagement to multiple forms of financing.

Doctor of Nursing Practice Program Development: Reengineering Health Care

In this article, we describe the developmental process of a Doctor of Nursing Practice (DNP) program that uses interdisciplinary resources to create unique DNP curriculum opportunities. Other schools may benefit from this experience in the development of their own DNP programs. The program delivers an innovative curriculum from post-baccalaureate to doctorate, emphasizing health care engineering and interdisciplinary collaboration among faculty, hospitals, community leaders, and policymakers. This DNP program is uniquely situated to provide leadership in solving complex clinical problems through its partnership with the Regenstrief Center for Healthcare Engineering, the School of Pharmacy, the Homeland Security Institute, and the Center on Aging and the Life Course. Doctoral coursework, interdisciplinary collaboration, health care engineering/systems approaches, and new knowledge result in uniquely qualified providers. Post-baccalaureate students complete the university's Adult Nurse Practitioner program or its developing Pediatric Nurse Practitioner program during the first 2 years of the 4-year curriculum. A total of 83 post-baccalaureate credit hours include 1,526 hours of supervised clinical practice, a health policy residency, and cognate residencies in an area of specialization. The seven core competencies recommended by the American Association of Colleges of Nursing are incorporated into the curriculum.

The Irish health system: developments in strategy, structure, funding and delivery since 1980

As the Irish health system embarks upon its first major structural reorganisation in over 30 years, developments within this system over the past two decades are assessed. Real cuts in health expenditure achieved in the 1980s contrast sharply with the unprecedented increase in resources devoted to the health system in the 1990s. While successive statements of health strategy have prioritised the objectives of equity, efficiency and quality of care, questions arise regarding the return achieved with the increased investment. With higher levels of economic growth, more people have been buying private health insurance such that almost half the population are now privately insured. At the same time, the numbers with eligibility for health services without charge have decreased while those from lower socio-economic groups continue to have higher levels of utilisation. Equity issues arise, however, with regard to access to public hospitals as the rate of growth in admissions for private patients outstrips that for public patients. The establishment of a National Treatment Purchase Fund to purchase treatment in private facilities for public patients on waiting lists raises efficiency and equity questions as the treatment of private patients in public hospitals is heavily subsidised while the State pays full cost for the treatment of public patients in private facilities.

Analysing the Greek health system: a tale of fragmentation and inertia

The Greek health system does not yet offer universal coverage and has fragmented funding and delivery. Funding is regressive, with a reliance on informal payments, and there are inequities in access, supply and quality of services. Inefficiencies arise from an over reliance on relatively expensive inputs, as evidenced by the oversupply of specialists and under-supply of nurses. Resource allocation mechanisms are historical and political with no relation to performance or output, therefore providers have little incentive to improve productivity. Some options for future health system reform include focusing on coordinating funding by developing a monopsony purchaser with the aim of improving quality of services and efficiency in the health system and changing provider incentives to improve productivity.

The Italian health-care system

Italy's national health service is statutorily required to guarantee the uniform provision of comprehensive care throughout the country. However, this is complicated by the fact that, constitutionally, responsibility for health care is shared between the central government and the 20 regions. There are large and growing differences in regional health service organisation and provision. Public health-care expenditure has absorbed a relatively low share of gross domestic product, although in the last 25 years it has consistently exceeded central government forecasts. Changes in payment systems, particularly for hospital care, have helped to encourage organisational appropriateness and may have contributed to containing expenditure. Tax sources used to finance the Servizio Sanitario Nazionale (SSN) have become somewhat more regressive. The limited evidence on vertical equity suggests that the SSN ensures equal access to primary care but lower income groups face barriers to specialist care. The health status of Italians has improved and compares favourably with that in other countries, although regional disparities persist.