Adaptation and restructuring of an academic anesthesiology department during the COVID-19 pandemic in New York City: Challenges and lessons learned.

The novel SARS-CoV-2 pandemic starting in 2019 profoundly changed the world, and thousands of residents of New York City were affected, leading to one of the most acute surges in regional hospital capacity. As the largest academic medical center in the Bronx, Montefiore Medical Center was immediately impacted, and the entire hospital was mobilized to address the needs of its community. In this article, we describe our experiences as a large academic anesthesiology department during this pandemic. Our goals were to maximize our staff's expertise, maintain our commitment to wellness and safety, and preserve the quality of patient care. Lessons learned include the importance of critical care training presence and leadership, the challenges of converting an ambulatory surgery center to an intensive care unit (ICU), and the management of effective communication. Lastly, we provide suggestions for institutions facing an acute surge, or subsequent waves of COVID-19, based on a single center's experiences.

[National organization of forensic medicine in France]. / Organisation nationale de la médecine légale en France.

Forensic medicine has long been characterized, in France, by diverse medical practices, which affected its recognition and development. A change was needed, Harmonization procedure includes the development of professional guidelines and allows forensic medicine to look at itself. However, the implementation of the recommendations is still far from complete. A national reform came into effect on 15 January 2011 and has defined a national reform of forensic medicine which includes funding by global budgets instead of fee-for-service. This reform allows easier organization and identification of forensic medicine units. One year later, tangible results are mixed. Forensic medicine is now more clearly identified but properly defined funding criteria are still lacking.

Reestruturação e peparo dos kits cirúrgicos para a implantação de um programa informatizado / Surgical kits: reorganization and preparation for informatizated program

Este estudo foi realizado no Centro Cirúrgico do Hospital Universitário da Universidade de São Paulo (HU-USP) e teve, conmo objetivo, reestruturar os kits cirúrgicos para a implantação de um sistema informatizado de suprimento de materiais...

[Development of organizations in Norwegian hospitals]. / Organisasjonsutvikling ved norske sykehus.

BACKGROUND: Hospitals in Norway are changing as a result of altered hospital environments and the constraints they are placed under. This article describes the organizational development in Norwegian hospitals from 1999 to 2005 and discusses whether the developments observed can be interpreted as a modernization of the Norwegian hospital system. MATERIAL AND METHODS: The article is based on a survey sent to all public hospitals in 2001, 2003 and 2005. In 2001 the hospitals were asked retrospectively about 1999. In 2005, 60 of 63 hospitals responded to the survey. RESULTS: Results indicate a consistent pattern of organizational development from 1999 to 2005. Some areas change to a greater degree than others; the most noticeable is decentralization in terms of financial routines and personnel responsibilities. Other major organizational developments include ring fencing of elective surgery, co-localization of hospital reception rooms and emergency wards, and increased use of computerized routines, both for patient management and treatment. INTERPRETATION: It has been demonstrated that Norwegian hospitals are able to change and adapt. Several standardized organizational and leadership structures recommended by official reviews are increasingly being adopted into practice. Hospitals are being modernized.

[The catalogue of ambulatory sickness benefits -- realistic? Feasible? Put into practice?]. / Der Katalog stationsersetzender Leistungen -- Realistisch? Praktikabel? Umgesetzt? Ambulantes Operieren am Krankenhaus.

Ambulatory surgery at German hospitals is an underdeveloped field. New legal regulations allow contracts between hospitals and insurance companies which will improve this situation. Besides the establishment of quality parameters and a fixed payment for the operations the contract lists 307 operations which can be performed on an outpatient basis. However, only few operations need to be done obligatory as ambulatory surgery. This reflects just incompletely what is already operated ambulatory outside the hospitals. Due to altered financial structures in case of in-patient treatment and because of a decrease of hospital beds, the listed operations in the contract may be reviewed and ambulatory surgery at the hospitals will increase in the future. The hospitals need to change their structure to establish successfully ambulatory surgery within the hospital setting. Finally, German patients need to be convinced that operations done on an out-patient basis show the same quality standards like procedures under in-patient conditions.

[Does co-operation research provide approaches to explain the changes in the German hospital market?]. / Bietet die Kooperationsforschung Ansätze zur Erklärung des Wandels auf dem deutschen Krankenhausmarkt?

UNLABELLED: The German hospital market faces an extensive process of consolidation. In this change hospitals consider cooperation as one possibility to improve competitiveness. AIM: To investigate explanations of changes in the German hospital market by theoretical approaches of cooperation research. METHOD: The aims and mechanism of the theories, their relevance in terms of contents and their potential for empirical tests were used as criteria to assess the approaches, with current and future trends in the German hospital market providing the framework. Based on literature review, six theoretical approaches were investigated: industrial organization, transaction cost theory, game theory, resource dependency, institutional theory, and co-operative investment and finance theory. In addition, the data needed to empirically test the theories were specified. RESULTS: As a general problem, some of the theoretical approaches set a perfect market as a precondition. This precondition is not met by the heavily regulated German hospital market. Given the current regulations and the assessment criteria, industrial organization as well as resource-dependency and institutional theory approaches showed the highest potential to explain various aspects of the changes in the hospital market. CONCLUSION: So far, none of the approaches investigated provides a comprehensive and empirically tested explanation of the changes in the German hospital market. However, some of the approaches provide a theoretical background for part of the changes. As this dynamic market is economically of high significance, there is a need for further development and empirical testing of relevant theoretical approaches.

The economic benefit of organizational restructuring of the cardiothoracic intensive care unit.

OBJECTIVES: Compare cost/benefits of organizational restructuring of the cardiac intensive care unit (CICU). DESIGN: Prospective, with a retrospective control period. SETTING: Academic medical center. PARTICIPANTS: Sixty-six CICU patients (prospective) and 57 patients who received care before restructuring (retrospective) were compared. Entrance criteria were constant for both study periods. INTERVENTIONS: The CICU was restructured from a level III ICU to a level I ICU with the initiation of a consultant CICU service. The CICU service provided an attending physician dedicated to ICU care daily. All cardiac patients admitted into the CICU received consultation by the CICU service. MEASUREMENTS AND MAIN RESULTS: The average postoperative intubation time decreased during the intervention period (61% extubated within 6 hours v 12%, p = 0.004). Pharmacy, radiology, laboratory, and ICU costs decreased 279 US dollars (p = 0.004), 196 US dollars (p = 0.003), 190 US dollars (p = 0.15), and 470 US dollars (p = 0.12), respectively. The ICU length of stay (0.28 days shorter) as well as the overall postsurgery stay (0.54 days shorter) were reduced in the intervention period (p = 0.11 and 0.10, respectively). CONCLUSIONS: The CICU service significantly reduced both total ICU-related costs ($1,173/patient) and overall costs (2,285 US dollars/patient) during the intervention period. Professional fees only reduced overall savings by 8%. These results indicate that organizational restructuring of the CICU to newer models can reduce costs associated with cardiac surgery.

Trabalhando a missäo de um hospital como facilitador da mudança organizacional: limites e possibilidades / Developing the hospital's mission to facilitate organizational change: limits and possibilities

Apresenta algumas consideraçöes encontradas no campo da Teoria Geral da Administraçäo, sobre o papel da definiçäo de "objetivos organizacionais"em um processo de mudança das organizaçöes em geral. Mesmo reconhecendo a validade de parte do questionamento feito por certos autores que, no limite, negam a possibilidade de se imprimir "uma" direcionalidade para a organizaçäo com base na explicitaçäo dos seus objetivos formais ou oficiais, apresenta e discute sua experiência, no setor saúde, de definiçäo da missäo (uma forma de "traduçäo" de objetivos organizacionais) como estratégia de melhorar a comunicaçäo dentro da equipe e da criaçäo de uma cultura de responsabilidade frente ao usuário.

[Quality management in rheumatologic rehabilitation at a time of structural change]. / Qualitätsmanagement in der rheumatologischen Rehabilitation in einer Zeit des strukturellen Wandels.

Quality assurance in rehabilitation of rheumatic diseases follows two programs, one developed by VDR (Verband Deutscher Rentenversicherungsträger) and the other developed by DGRh (Deutsche Gesellschaft für Rheumatologie). After introducing Total Quality Management to a rehabilitation center quality measurably increased. This improvement has been achieved by goal-directed steps and modification of clinical structures. Up to now patients' needs and the revision of in-patient treatment have been the central part af these activities. By organizing several special training courses staff has become more content and qualified. New forward-looking perspectives have been worked out in cooperation with other partners.

[Breast carcinoma in routine surgery. Challenges and reality]. / Das Mammakarzinom im chirurgischen Alltag. Forderungen und Realität.

This is a brief comment on results in the common surgical treatment of breast cancer. Based on guiding-lines given by the surgical congress 1985 the decentralized treatment routine as it is common today has been analysed and its results have been applied to our regional structures. Under the premises of standardized diagnosis as well as surgical and postoperative treatment the decentralized treatment of breast cancer is still supported and considered useful. Main critical point in the whole therapy concept is the postoperative treatment, especially the adjuvant therapy. Looking for future solutions it seems to be more effective to reduce the amount of surgical facilities for the benefit of profiling the remaining ones. This could be applicable for the treatment of other diseases as well. The improvements that would result from this conceptional concentration would be profitable as well for the patients as for the surgeons.

[Future organizational structures for old age homes and nursing homes]. / Zukünftige Organisationsstrukturen für Alters- und Pflegeheime.

New organizational concepts are of significant importance for homes for the elderly. Restructuring of the homes is necessary because of some fundamental weaknesses in the contemporary elderly care system as well as the shift of the level of aspiration which is expected by the formation of the so-called "new elderly". Main topics in the restructuring process are consumer orientation, core organizational competences, and core processes. The challenge for the management is not to copy "ideal" models but to develop and to implement new structures which fit into the special context of the homes.

Financing reforms in the German hospital sector: from full cost cover principle to prospective case fees.

OBJECTIVES: The authors provide an overview of the hospital sector in Germany with a focus on the impact of recent reform legislation on this sector. METHODS: Data from the Federal Statistics Office, the Ministry of Health, and the Federal Association of Physicians are synthesized with information obtained from a general review of the literature. RESULTS: Before the implementation of recent health-care reforms, the German health-care system has been sharply divided into inpatient and ambulatory care sectors, resulting in a fragmented system of care delivery. All hospital operating costs were fully covered through per diem charges. The 1992 Health Care Structure Act and subsequent pieces of legislation have introduced new mechanisms to improve cost efficiency in the hospital sector and increase coordination between the inpatient and outpatient care. These measures notably include implementing an inpatient prospective payment system and permitting ambulatory surgery and care services to be offered in inpatient settings. CONCLUSIONS: Whereas prospective payments have greatly reduced the length of stay, hospitals were reluctant to offer ambulatory surgery due to budgetary constraints and the high level of ambulatory surgery by office-based physicians. The reforms passed have not yielded substantial cost savings. These reforms offer a natural experiment that could benefit from national and international studies on the impact of hospital sector redesign on management, financing, and patient outcomes.