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Harolds JA. Quality and Safety in Healthcare, Part LXX: Qualifications and Leadership of the Chief Medical Officer. Clin Nucl Med 2021; 46:471-473. [PMID: 32371616 DOI: 10.1097/rlu.0000000000003035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The chief medical officer ideally has a degree in business, hospital administration, or related subjects and has also pursued training in leadership. This is very important to be able to read and interpret financial documents, understand the language of hospital executives, and be able to advise the administrators and physicians on many projects. The chief medical officer must be trusted by both the C-suite executives and the medical staff and be able to communicate effectively and diplomatically with both. In order to optimize value, it is important to engage the medical staff and to align the goals of not only the executives and doctors, but also of the patients and their families.
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Affiliation(s)
- Jay A Harolds
- From the Advanced Radiology Services and the Division of Radiology and Biomedical Imaging, College of Human Services, Michigan State University, Grand Rapids, MI
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2
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Bakewell Z, Davies D, Allanby L, Dhonye Y. Pandemically challenged: Developing a ward-based cross-skilling programme. Med Educ 2020; 54:1181-1182. [PMID: 32438448 PMCID: PMC7280587 DOI: 10.1111/medu.14252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 05/07/2023]
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3
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Affiliation(s)
| | - Adam I Perlman
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Anjali Bhagra
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
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4
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Nacher M, Deungoue S, Brousse P, Adenis A, Couppié P, Sobesky M. [The interplay between isolation and precariousness, and hospitalization duration in French Guiana]. Rev Epidemiol Sante Publique 2020; 68:125-132. [PMID: 32035728 DOI: 10.1016/j.respe.2019.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/03/2019] [Accepted: 09/19/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND French Guiana faces singular health challenges: poverty, isolation, structural lag, difficulties in attracting health professionals. Hospital stays exceed the recommended durations. The present study aimed to model the impact of precariousness and geographic isolation on the hospital duration performance indicator and to recalculate the indicator after incrementing severity by 1 unit when patients were socially precarious. METHODS Cayenne hospital data for 2017 were used to model the hospital duration performance indicator (IP-DMS) using quantile regression to study the impact of geographic and social explanatory variables. This indicator was computed hypothesizing a 1 unit increment of severity for precarious patients and by excluding patients from isolated regions. RESULTS Most excess hospitalization days were linked to precariousness: the sojourns of precarious patients represented 47% of activity but generated 71% of excess days in hospital. Quantile regression models showed that after adjustment for potential confounders, patients from western French Guiana and Eastern French Guiana, precarious patients and the interactions terms between residence location and precariousness were significantly associated with IP-DMS increases. Recalculating the IP-DMSafter exclusion of patients from the interior and after increasing severity by 1 notch if the patient was precarious led to IP-DMS levels close to 1. CONCLUSION The results show the nonlinear relationship between the IP-DMS and geographical isolation, poverty, and their interaction. These contextual variables must be taken into account when choosing the target IP-DMS value for French Guiana, which conditions funding and number of hospital beds allowed in a context of rapid demographic growth.
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Affiliation(s)
- M Nacher
- SD -CIC Inserm 1424, centre hospitalier de Cayenne, rue des Flamboyants, 97300 Cayenne, Guyane.
| | - S Deungoue
- SD -CIC Inserm 1424, centre hospitalier de Cayenne, rue des Flamboyants, 97300 Cayenne, Guyane
| | - P Brousse
- Département des centres délocalisés de prévention et de soins, centre hospitalier de Cayenne, Guyane
| | - A Adenis
- SD -CIC Inserm 1424, centre hospitalier de Cayenne, rue des Flamboyants, 97300 Cayenne, Guyane
| | - P Couppié
- Service de dermato-vénéréologie, centre hospitalier de Cayenne, Guyane
| | - M Sobesky
- Département d'information médicale, centre hospitalier de Cayenne, Guyane
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5
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Rabkin SW, Dahl M, Patterson R, Mallek N, Straatman L, Pinfold A, Charles MK, van Gaal S, Wong S, Vaghadia H. Physician engagement: the Vancouver Medical Staff Association engagement charter. Clin Med (Lond) 2019; 19:278-281. [PMID: 31308103 PMCID: PMC6752238 DOI: 10.7861/clinmedicine.19-4-278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Engagement of physicians with their healthcare community or institution should be a central issue in healthcare because it can be translated into improved patient care, enhanced well-being for physicians as well as safer, more effective and less costly healthcare. To accomplish the mission/goal of meaningful physician engagement, we set about to establish a 'charter' for physician engagement. We defined our concept of meaningful physician engagement and customised the engagement spectrum construct for physician relationship with their healthcare community or institution. While recognising the importance of physician leaders within the hierarchical system for efficacy of organisational management, relying only on physicians in formal executive positions is insufficient for developing physician engagement. There is a need for widespread physician engagement across the organisation. The objective is both an improvement in patient care and in physician well-being.
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Affiliation(s)
- Simon W Rabkin
- Vancouver General Hospital, Vancouver, Canada and president of medical staff, Vancouver Medical, Dental and Allied Staff Association, Vancouver, Canada
| | - Marshall Dahl
- University of British Columbia and Vancouver Hospital, Vancouver, Canada and former president of medical staff, Vancouver Medical, Dental and Allied Staff Association, Vancouver, Canada
| | - Ryan Patterson
- Vancouver General Hospital, Vancouver, Canada and vice president of medical staff, Vancouver Medical, Dental and Allied Staff Association, Vancouver, Canada
| | - Noa Mallek
- Vancouver General Hospital, Vancouver, Canada and secretary medical staff, Vancouver Medical, Dental and Allied Staff Association, Vancouver, Canada
| | - Lynn Straatman
- University of British Columbia, medical director cardiac function clinic, Vancouver Hospital, Vancouver, Canada and chair advocacy committee, Vancouver Medical, Dental and Allied Staff Association, Vancouver, Canada
| | | | - Marthe Kenny Charles
- University of British Columbia, medical microbiologist, Vancouver General Hospital, Vancouver, Canada
| | - Stephen van Gaal
- University of British Columbia, staff neurologist, Vancouver General Hospital, Vancouver, Canada
| | - Sophia Wong
- University of British Columbia, medical lead, Vancouver Coastal Health Laboratories, program director, UBC Medical Biochemistry Residency Training Program, Medical Biochemist, Vancouver General Hospital, Vancouver, Canada
| | - Himat Vaghadia
- University of British Columbia, staff anaesthesiologist, Vancouver General Hospital, Vancouver, Canada
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6
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Lee RP, Bamford C, Poole M, McLellan E, Exley C, Robinson L. End of life care for people with dementia: The views of health professionals, social care service managers and frontline staff on key requirements for good practice. PLoS One 2017. [PMID: 28622379 PMCID: PMC5473529 DOI: 10.1371/journal.pone.0179355] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Evidence consistently shows that people with advanced dementia experience suboptimal end of life care compared to those with cancer; with increased hospitalisation, inadequate pain control and fewer palliative care interventions. Understanding the views of those service managers and frontline staff who organise and provide care is crucial in order to develop better end of life care for people with dementia. Methods and findings Qualitative interviews and focus groups were conducted from 2013 to 2015 with 33 service managers and 54 staff involved in frontline care, including doctors, nurses, nursing and care home managers, service development leads, senior managers/directors, care assistants and senior care assistants/team leads. All were audio recorded and transcribed verbatim. Participants represented a diverse range of service types and occupation. Transcripts were subject to coding and thematic analysis in data meetings. Analysis of the data led to the development of seven key themes: Recognising end of life (EOL) and tools to support end of life care (EOLC), Communicating with families about EOL, Collaborative working, Continuity of care, Ensuring comfort at EOL, Supporting families, Developing and supporting staff. Each is discussed in detail and comprise individual and collective views on approaches to good end of life care for people with dementia. Conclusions The significant challenges of providing good end of life care for people with dementia requires that different forms of expertise should be recognised and used; including the skills and knowledge of care assistants. Successfully engaging with people with dementia and family members and helping them to recognise the dying trajectory requires a supportive integration of emotional and technical expertise. The study strengthens the existing evidence base in this area and will be used with a related set of studies (on the views of other stakeholders and observations and interviews conducted in four services) to develop an evidence-based intervention.
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Affiliation(s)
- Richard Philip Lee
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- * E-mail:
| | - Claire Bamford
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Marie Poole
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Emma McLellan
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Catherine Exley
- Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Louise Robinson
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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7
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Lovink MH, Persoon A, van Vught AJAH, Schoonhoven L, Koopmans RTCM, Laurant MGH. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study. BMJ Open 2017; 7:e015134. [PMID: 28600370 PMCID: PMC5734255 DOI: 10.1136/bmjopen-2016-015134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/13/2017] [Accepted: 03/13/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. METHODS AND ANALYSIS This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. ETHICS AND DISSEMINATION The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government.
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Affiliation(s)
- Marleen Hermien Lovink
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud university Medical Center, Radboud Institute for Health Sciences, the Netherlands
| | - Anneke JAH van Vught
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Lisette Schoonhoven
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
- University of Southampton, Faculty of Health Sciences, Southampton, UK
| | - Raymond TCM Koopmans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
- Joachim & Anna, Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Miranda GH Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
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8
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Peota C. 8 big (and 14 small) ideas for building resiliency. How to tend to the well-being of a medical staff. Minn Med 2016; 99:14-20. [PMID: 30476427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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9
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Frandsen B. Communicating Effectively: Success Depends On It. Provider 2015; 41:33-35. [PMID: 26939145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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10
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Marbury D. Delegating tasks staff enhances team-based care. Med Econ 2014; 91:49-51. [PMID: 25318307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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11
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Ryckebusch O. [Dunkerque's hospital during World war I]. Rev Soc Fr Hist Hop 2014:67-74. [PMID: 25033617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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12
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Hills L. Managing cliques and exclusionary behavior within your medical practice team. J Med Pract Manage 2014; 29:373-377. [PMID: 25108986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Unfortunately, cliques aren't a problem that you left behind in high school. Workplace cliques can be just as or even more troubling for you today, especially if they have the potential to affect your career, employee morale and performance, and your medical practice more broadly. This article describes workplace cliques in detail. It provides examples of exclusionary and ostracizing behaviors that are often associated with cliques. And it describes the prevalence and effects of cliques in today's workplace. This article also provides practice managers with 10 tips for discouraging and managing cliques. It describes five common workplace cliques: management, veteran, prior relationship, status, and homophily. It offers medical staff employees 10 strategies for working effectively alongside of a clique. Finally this article describes the pitfalls and risks of belonging to a workplace clique.
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13
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Jarousse LA. Physician engagement (getting your docs on board!). Hosp Health Netw 2014; 88:41-47. [PMID: 24881304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
How can hospitals better engage with docs when so many of them are feeling overwhelmed, underappreciated and underpaid?
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14
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Warnet S. [Result and perspectives on cooperation between health professionals]. Rev Infirm 2014:6. [PMID: 24881226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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15
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Brinkman A. Disparities undermine nursing. Nurs N Z 2013; 19:30. [PMID: 23614310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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16
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Madke B. Are doctors soft targets for government? Indian J Med Ethics 2012; 9:220. [PMID: 22864091 DOI: 10.20529/ijme.2012.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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17
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Woodka M. Right-size staff a good bet: A staffing expert offers advice on how to ensure a facility has the right staff at the right time. Provider 2012; 38:39-42. [PMID: 22662479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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18
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Dyer C. A second NHS trust turns to the army for help with staffing. BMJ 2012; 344:e580. [PMID: 22271604 DOI: 10.1136/bmj.e580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Buchinger SM. [Model project improves nursing home physician access: step by step to optimal medical care]. Pflege Z 2011; 64:350-352. [PMID: 21735633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Sascha M Buchinger
- Altenhilfe Beim Deutschen Roten Kreuz, Landesverband Baden-Württemberg e.V.
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20
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Abstract
This article presents a thorough analysis of dual practice among physicians who work in both the public and private sectors. A conceptual framework is presented to help the reader understand dual practice and the contexts where it takes place. The article reviews the existing theoretical and empirical literature on this form of dual practice among physicians. It analyzes the extent of this phenomenon, the underlying factors that motivate physicians to engage in dual practice, and the main implications of their decision to do so. It also examines and discusses current policies that address dual practice. In this regard, the article provides some qualified support for the use of "rewarding" policies to retain physicians in the public sectors of more developed countries, while "limiting" policies are recommended for developing countries - with the caveat that the policies should be accompanied by the strengthening of institutional and contracting environments. The article highlights the lack of quality evaluative evidence regarding the consequences of dual practice on the delivery of health care services. It concludes that the overall impact of dual practice remains an open question that warrants more attention from researchers and policy makers alike.
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21
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Zahaluk D. What your staff (really) wants from you. Med Econ 2010; 87:45-46. [PMID: 21133252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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22
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Schiller B, Neitzer A, Doss S. Perceptions about renal replacement therapy among nephrology professionals. Nephrol News Issues 2010; 24:36, 38, 40 passim. [PMID: 20942330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Usage of renal replacement modalities available for the treatment of end stage renal disease varies widely between countries, indicating that non-medical factors contribute to the choice of therapy. In the United States, 93% of the patients are treated with in-center hemodialysis (HD), about 7% undergo peritoneal dialysis (PD) and less than 1% are on home HD. In comparison, a Northern California-based nonprofit dialysis provider with home dialysis centers throughout the United States has achieved a home therapy penetration of 22%, the highest proportion of home therapies among U.S. dialysis providers. To better understand the perceptions about the various modality choices among caretakers (nephrologists and nurses) in this organization a short questionnaire was used. We examined the hypothetical setting of the caretakers being in the patient role. More than 90% of the nephrology professionals chose a home therapy as initial treatment option with close to equal distribution between PD and home HD. This pattern persisted for maintenance therapy with home HD being the preferred modality. Nephrologists' and nurses' perception of who makes modality decisions varied profoundly.
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23
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Welch SS, Gregory AG. The joint commission revises medical staff standard 01.01.01 impacting medical staff bylaws, leadership & conflict resolution. J Med Assoc Ga 2010; 99:22-29. [PMID: 20465051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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24
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Taylor CL. Attitudes toward physician-nurse collaboration in anesthesia. AANA J 2009; 77:343-348. [PMID: 19911643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The purpose of this study was to compare the attitudes of anesthesiologists and nurse anesthetists toward collaboration with each other. Data for this descriptive, comparative study were gathered through a mailed survey to 501 nurse anesthetists and 353 anesthesiologists licensed to practice in 7 state of the United States. Attitude toward collaboration was measured using an adaptation of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration. The mean total scores were compared using the t test for independent groups. Mean total scores were higher for the nurse anesthetist group (n = 238) compared with the anesthesiologist group (n = 66). Analysis demonstrated that this difference was significant (t = 14.6, P < .05). Additional analyses failed to show a significant difference based on sexual gender. The results of this study provide some evidence that the divergent perspectives regarding collaboration previously demonstrated between physicians and nurses may also exist in the specialty field of anesthesia. This study provided no support for the supposition that gender contributes to the differences in attitude toward collaboration between physicians and nurses.
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Affiliation(s)
- Cassandra L Taylor
- Charleston Area Medical Center, School of Nurse Anesthesia, Charleston, West Virginia, USA.
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25
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26
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Abstract
Drug specialist staff and agencies have been identified as having a critical role in responding to alcohol and other drug-related harm. This role must be seen in the context of the broad needs of people affected by drug use and the services that they utilize. Unfortunately, as in generic mainstream services, skill development, expertise, organizational structures and resources do not always support the demands of the drug specialist role. In order to develop the drug specialist work-force we must first review the evidence about the factors that influence effective practice. The available research indicates that a range of strategies is required and that these should not only focus on building the capacity of individuals, but also on organizations and systems. Substantial effort in capacity building is required in order to fulfil the expectations created by the title "drug specialist".
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Affiliation(s)
- Steve J Allsop
- Drug and Alcohol Office, Mt Lawley Western Australia and Centre for International Health, Division of Health Sciences, Curtin University of Technology, Perth, Western Australia
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27
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Kirch DG. Why can't healthcare professionals work together better? Medscape J Med 2008; 10:224. [PMID: 19008985 PMCID: PMC2580097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Darrell G. Kirch
- Association of American Medical Colleges, Washington, DC Author's
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28
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Molzahn AE, Hibbert MP, Gaudet D, Starzomski R, Barrett B, Morgan J. Managing chronic kidney disease in a nurse-run, physician-monitored clinic: the CanPREVENT experience. Can J Nurs Res 2008; 40:96-112. [PMID: 18947094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The purpose of this study was to examine the nature of the care provided to people with chronic kidney disease within a larger study of nurse-run, physician-monitored clinics, as well as how patients, nurses, and nephrologists described their experience with the clinics. Interviews were conducted with 7 nurses, 5 physicians, and 23 patients. Data collection also entailed review of 40 randomly selected charts. Identified themes related to characteristics of the nurse, patient-centred care, health promotion, teaching, dealing with problems, time, protocols, consultation and referrals, clinic logistics, paperwork/documentation, and nurse-physician collaboration. Challenges and outcomes were also described as part of the experience with the clinic. Patients were actively engaged in self-management and reported high levels of satisfaction with care as well as improvements in selected outcomes. Overall, the perceptions of this model of care were positive and the approach warrants further exploration.
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Affiliation(s)
- Anita E Molzahn
- Faculty of Nursing, University of Victoria, British Columbia, Canada.
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29
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Owens K. A retrospective of EMR implementation in one large practice. J Med Pract Manage 2008; 24:102-104. [PMID: 19174970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article is the last of a six-part series regarding the implementation of an electronic medical record system in a large multisite physician practice. This particular article is meant to provide some insight regarding two matters any practice delving into this project should be prepared to consider: 1) don't underestimate the value of utilizing as many employees as possible in the pre-implementation planning stage; and 2) have a detailed plan for entering patient history information.
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Affiliation(s)
- Kathleen Owens
- ENT and Allergy Associates, LLP, 560 White Plains Road, Suite 500, Tarrytown, NY 10591, USA.
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30
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Lawrance KAG, Lawler SA. Campus physicians' tobacco interventions with university students: a descriptive study of 16 Ontario university clinics. Patient Educ Couns 2008; 70:187-192. [PMID: 18037601 DOI: 10.1016/j.pec.2007.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 09/21/2007] [Accepted: 09/22/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE About one-quarter of Canadian post-secondary students smoke cigarettes. We examined how physicians from Ontario university health clinics intervene with these young adult smokers. METHOD A convenience sample of 16 universities was identified and surveys were hand-delivered to all 228 physicians from these schools. A total of 125 doctors (54.82%) responded; 70 were from universities that were involved in a government-sponsored, coordinated, multi-campus, tobacco control initiative. RESULTS Twenty percent of doctors reported asking all or almost all patients about tobacco use; 25.22% asked fewer than half. Describing how they respond to patients identified as smokers, 96.00% of physicians advised cessation, 72.00% offered assistance, and 64.00% arranged for follow-up. Doctors discussed patients' tobacco use with 78.59% of smokers. Nicotine replacement therapies were rarely offered to patients wanting to quit. Doctors from universities involved in the tobacco control initiative were more likely to keep patient education materials in the examining room. CONCLUSION Because most doctors ask only some patients about tobacco use, they may be missing opportunities to provide appropriate advice and assistance to all smokers. PRACTICE IMPLICATIONS Physician education and support to the clinic are needed to improve the frequency and quality of physician-delivered smoking cessation services to post-secondary students.
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Schlichting JA, Quinn MT, Heuer LJ, Schaefer CT, Drum ML, Chin MH. Provider perceptions of limited health literacy in community health centers. Patient Educ Couns 2007; 69:114-20. [PMID: 17889494 PMCID: PMC2246059 DOI: 10.1016/j.pec.2007.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 07/29/2007] [Accepted: 08/09/2007] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To examine techniques used by community health center (HC) providers to care for patients with limited health literacy (LHL). METHODS Survey mailed to 803 HC providers in 10 Midwestern states. Response rate was 47.5%. Associations between variables were examined using generalized estimating equations (GEE) models to account for clustering of respondents within HCs. RESULTS The average provider estimates of LHL prevalence among English- and Spanish-speaking patients were 41+/-24% (mean+/-S.D.) and 48+/-30%, respectively. Those with training in health literacy were more likely to have patients repeat instructions back to check understanding (OR=2.05 and p=0.04) and were more likely to give out health education materials designed for patients with LHL (OR=2.80 and p=0.0002). Providers differed by type in encouraging patients to bring friends or family members to appointments (p=0.02). CONCLUSION Providers estimate LHL to be highly prevalent in their HCs, and use various techniques to assist patients. PRACTICE IMPLICATIONS Training in health literacy is associated with increased usage of evidence-based techniques to assist patients with LHL. Providers at all levels would likely benefit from LHL training. Most providers believe providing health education materials designed specifically for patients with LHL would be very helpful.
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Affiliation(s)
- Jennifer A Schlichting
- Department of Medicine , Diabetes Research and Training Center, The University of Chicago, IL, United States.
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Kaasalainen S, Coker E, Dolovich L, Papaioannou A, Hadjistavropoulos T, Emili A, Ploeg J. Pain management decision making among long-term care physicians and nurses. West J Nurs Res 2007; 29:561-80; discussion 581-8. [PMID: 17548894 PMCID: PMC5104556 DOI: 10.1177/0193945906295522] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to explore attitudes and beliefs that affect decisions about prescribing and administering pain medications in older adults who live in long-term care (LTC), with a particular emphasis on those with cognitive impairment. At each of the four participating LTC facilities, data were gathered from three separate groups of health care professionals: physicians, registered nurses, and registered practical nurses. Based on grounded theory, a model was developed that highlighted critical decision points for nurses and physicians regarding pain management. The major themes that emerged from the data concerned pain assessment (lack of recognition of pain, uncertainty about the accuracy of pain assessment and diagnosis) and treatment (reluctance to use opioids, working to individualize pain treatments, issues relating to physician trust of the nurse on prescribing patterns). These findings may facilitate the development of innovative approaches to pain management in LTC settings.
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Abstract
High-quality pediatric emergency care can be provided only through the collaborative efforts of many health care professionals and child advocates working together throughout a continuum of care that extends from prevention and the medical home to prehospital care, to emergency department stabilization, to critical care and rehabilitation, and finally to a return to care in the medical home. At times, the office of the pediatric primary care provider will serve as the entry site into the emergency care system, which comprises out-of-hospital emergency medical services personnel, emergency department nurses and physicians, and other emergency and critical care providers. Recognizing the important role of pediatric primary care providers in the emergency care system for children and understanding the capabilities and limitations of that system are essential if pediatric primary care providers are to offer the best chance at intact survival for every child who is brought to the office with an emergency. Optimizing pediatric primary care provider office readiness for emergencies requires consideration of the unique aspects of each office practice, the types of patients and emergencies that might be seen, the resources on site, and the resources of the larger emergency care system of which the pediatric primary care provider's office is a part. Parent education regarding prevention, recognition, and response to emergencies, patient triage, early recognition and stabilization of pediatric emergencies in the office, and timely transfer to an appropriate facility for definitive care are important responsibilities of every pediatric primary care provider. In addition, pediatric primary care providers can collaborate with out-of-hospital and hospital-based providers and advocate for the best-quality emergency care for their patients.
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Abstract
Important issues in the transition from curative treatment to palliative care are agreement, timing, and decision making. A survey of 309 nurses and 415 physicians in Sweden showed that 61% of the nurses and 83% of the physicians thought agreement was current practice. None said that the decisions were made too early, but 19% of the nurses and 14% of the physicians thought that they often were made too late. Very few respondents stated that such decisions are changed, 0% and 1%, respectively. More than half of the informants made detailed comments on such transitions indicating that awareness and flexibility are desirable to make well-informed decisions. Three themes that emerged from the analysis concerning the decision to stop curative treatment and focus on palliative care were that the staff members should (if possible) make such decisions in agreement and should sometimes make the decisions earlier and that well-based reasons are required to make changes.
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EDs pool resources to weather flood. ED Manag 2006; 18:112-3. [PMID: 17040022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
When disaster strikes your community, creativity can go a long way toward keeping your ED up and running, but cooperating with neighboring facilities can double your available resources in a hurry. Contact all unscheduled staff members and request that they accept additional shifts during the crisis. If nearby facilities are shut down, contact their manager to ascertain availability of their staff and supplies. Seek additional staffing help from local residency programs.
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Burrows A, Humphrey S. A patient satisfaction survey of a nurse-led colorectal clinic. Nurs Times 2006; 102:31-3. [PMID: 16967735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A new service was set up to achieve government targets to see patients with signs or symptoms of a possible colorectal cancer within two weeks of referral from their GP. The new clinics were nurse-led. A patient satisfaction survey was used to assess patients' opinions about the clinic. The results showed patients had a positive view of the clinic.
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Abstract
BACKGROUND In 2005, Ascension Health's strategic direction sharpened the focus of its 2002 Call to Action to provide "Healthcare That Works, Healthcare That Is Safe, and Healthcare That Leaves No One Behind, for Life," Ascension Health has used a framework, the Five Cs of Culture Change, to address the call to action--comprehension (understanding the problem), compassion (spirituality and commitment), collaboration (teaming between subcultures and providers), coordination (system processes, infrastructure, and ideation), and convergence (leadership of local culture with spread and dissemination of new norms in a rapid way). THE FIVE CS OF CULTURE CHANGE AND CULTURE SURVEYS Climate (or culture) of safety results are provided from a baseline systemwide survey of front-line caregivers' assessments of teamwork and patient safety. The findings are aggregated at the hospital level, clinical area level, and caregiver role level, and fed back to executives, managers, and front-line caregivers. The final major element of culture change, and arguably the most important, involves the leadership and fortitude necessary to stimulate convergence of the culture on a new way of doing things. CONCLUSION Ascension Health will continue to use a systemwide culture survey for front-line assessments' of safety and teamwork across all clinical areas and to discover best practices and track progress in improving performance.
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York GK, Pearl RM. Physician Workflow At Kaiser Permanente. Health Aff (Millwood) 2006; 25:569-70; author reply 570. [PMID: 16522617 DOI: 10.1377/hlthaff.25.2.569-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chi BH, Sinkala M, Stringer EM, McFarlane Y, Ng'uni C, Myzece E, Goldenberg RL, Stringer JSA. Employment of off-duty staff: a strategy to meet the human resource needs for a large PMTCT program in Zambia. J Acquir Immune Defic Syndr 2005; 40:381-2. [PMID: 16249717 DOI: 10.1097/01.qai.0000159515.39982.c0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Baptiste L. Piloting a team approach in school nursing in the inner city. Community Pract 2005; 78:400-4. [PMID: 16317923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
School nurses have been identified as having a major role in delivering the NHS plan through their work with the school community. To achieve this, multi-skilled teams are perceived as the way forward. This article reports on a stakeholder evaluation of three expanded school nurse teams piloted in an inner city area. Focus groups and semi-structured interviews were conducted with school health and education staff who were involved in the project. The findings show that a team approach in school nursing is possible. However its success would depend on developing mechanisms such as equitable workloads, team leadership and development training, and effective communication.
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Abstract
Utilization of long-acting antipsychotic injections (depots) shows wide regional variation. In many countries, community psychiatric nurses (CPNs) administer depots but their concerns and attitudes regarding these drugs are seldom considered. We aimed to investigate attitudes and knowledge towards depots in a cross-sectional survey of CPNs in London, and compare them with those of psychiatrists obtained in a previous study. Three subscales of a depot attitude/knowledge questionnaire were used with additional items which referred to aspects of the CPN role. Participants were 70 CPNs who attended an academic meeting. Most CPNs reported that they were involved in treatment decisions (78%) although some CPNs seldom asked their patients about side effects (19%) and felt that they did not have sufficient time for consultations (23%) or training (23%). Several CPNs believed that depots are old fashioned (34%) and stigmatizing (44%). Compared to psychiatrists, CPNs believed more that depots compromised patient autonomy (28%, P = 0.003) and were coercive (42%, P < 0.001). Familiarity with depots and their knowledge of side effects were positively associated with favourable attitudes. CPNs have several strongly endorsed attitudes towards depot medication. Interprofessional group differences also exist which may undermine the treatment process. Training/refresher courses about depots should highlight systematic treatment decision-making and side effect monitoring which, in turn, may improve professionals' attitudes, knowledge and clinical monitoring of depots.
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Affiliation(s)
- M X Patel
- Division of Psychological Medicine, Institute of Psychiatry and GKT School of Medicine, De Crespigny Park, London, UK.
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Shichanin VV, Tregubov VN, Serdiuk BV. [Characteristics of work stimulation of the medical personnel in the treatment-and-prophylactic institutions]. Voen Med Zh 2005; 326:10-6, 80. [PMID: 15822771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Social and economic relations of the last years that were formed in our country have lead to the changes in approaches to administrative activity. Under conditions of administrative-and-command guidance the patriotism and requirements of production discipline ensured the highly effective work. Today the economic relations between employer and personnel are of the first priority. These principles can be attributed to the military medical collective activity. The algorithm developed during the investigation for stimulating the employees working in the in-patient military medical institutions suggests the following performance of measure complex directed to the improvement of professional training of managerial staff working in the military medical institutions work with subordinates, fulfilment of motivation activity, summing up the medical staff work.
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Affiliation(s)
- Richard B Gunderman
- Indiana University School of Medicine, Department of Radiology, Indianapolis, IN 46202-5200, USA.
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I M Sechenov Moscow Medical Academy. [Standardization system for health services of the Russian Federation. Guidelines for interaction of personnel in clinical departments and clinical diagnostic laboratories of health services during clinical laboratory studies]. Klin Lab Diagn 2004;:24, 33-5. [PMID: 15372882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Khoury SA, Mawajdeh S. Performance of health providers in primary health care services in Jordan. East Mediterr Health J 2004; 10:372-81. [PMID: 16212215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The study analysed time utilization by a sample of 111 physicians, nurses and midwives in 62 primary health care facilities in Jordan. The providers' activity over each shift was coded at 3-minute intervals using an activity sampling technique and patient-provider contact times were recorded. Overall, health providers spent the nearly half their time (48.7%) as down time' (waiting, breaks and non-work related activities), with 29.1% as clinical activities and 22.1% as non-clinical work-related activities. Physicians had higher clinical and down times than nurses and midwives; waiting for patients accounted for half the down time. The mean physician-patient contact time was 3.08 minutes. An appointment system is recommended to reduce down times for health providers and increase consultation times.
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Affiliation(s)
- S A Khoury
- Department of Community and Family Medicine, University of Jordan, Amman, Jordan
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Dimant J. The role of the consultant in long-term care facilities. J Am Med Dir Assoc 2004; 5:S59-66. [PMID: 14984613 DOI: 10.1097/01.jam.0000085797.95692.b9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Jacob Dimant
- Lutheran Augustana Center for Extended Care and Rehabilitation, Lutheran Medical Center, Brooklyn, New York 11220. USA.
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Morgan H, Habibi P, Swann E, Kilgallon C, Taylor C, McDonald P, Knott L, Stewart J. Let's work together. Interview by Kathy Oxtoby. Nurs Times 2003; 99:22-6. [PMID: 12630277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Helen Morgan
- Paediatric Intensive Care Unit, St Mary's Hospital, London
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Cox C, Farmer B. Can nurse practitioners replace junior doctors? Nurs Times 2003; 99:18-9. [PMID: 12617005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Carol Cox
- St Bartholomew School of Nursing & Midwifery, City University, London
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