Disseminating QI interventions.

BACKGROUND: Partnerships contributed to the success of three diverse health care quality improvement (QI) projects. The Partnerships for Quality (PFQ) Dissemination Planning Tool was used to identify the most appropriate partners to disseminate the QI interventions for three projects, that is, partners most likely to reach and influence the target user(s)-(1) the Catholic Healthcare Partners Heart Failure Partnership, a multisite demonstration of the efficacy of a collaborative approach in the management of heart failure, (2) the Center for Value Purchasing, a collaborative study of the effects of quality incentives on the delivery of chronic disease care, and (3) the New York State Information Dissemination project, a collaborative partnership that targeted dissemination of evidence-based practices in the long term care setting. RESULTS: The RE-AIM model, a construct to aid planning, implementation, and evaluation of health behavior interventions, was used as a framework to examine the impact of partnerships on the three collaborative projects. DISCUSSION: When carefully selected and nurtured, partnerships can substantially facilitate the dissemination and impact of quality improvement projects. The PFQ Dissemination Planning Tool was helpful in identifying and developing strategies for working with partners who could facilitate dissemination of promising practices. The RE-AIM model was a useful framework for examining the impact of the partnerships on the QI projects.

Going provincial: preceptoring and mentoring revisited in the health sciences. Part II--The evaluation.

Part I of this two part series, which was published in the Spring 2003 issue of Healthcare Management FORUM, described the Preceptor & Mentor Initiative for Health Sciences in BC, a provincial strategy to facilitate preceptoring and mentoring. Activities included creation of an educational web site and a UBC Continuing Studies preceptor course, and provincial workshops on preceptoring and mentoring. The purpose of this second article is to outline the philosophy, framework, results and interpretation of the Preceptor & Mentor Initiative's evaluation component.

An experiential learning simulation exercise for healthcare management students.

Preparing competent administrators to work in today's dynamic healthcare environment is a challenging task for contemporary educators. Experiential exercises in the classroom can contribute significantly to student training. This paper reviews the benefits to students of actively participating in simulations and role-plays, as well as the challenges in running such exercises. A simulation designed specifically for healthcare administration students is presented with details and implementation instructions. The intent of this article is to impart to other educators the learning experiences in running this particular simulation to inspire dialogue and program improvement. Readers are encouraged to create simulation exercises with optimum relevance for their students. Information to obtain e-mail versions of the simulation is also provided.

The organizational context of ethical dilemmas: a role-playing simulation for the intensive care unit.

The allocation of health care resources often requires decision makers to balance conflicting ethical principles. The resource-constrained intensive care unit (ICU) provides an ideal setting to study how decision makers go about their balancing act in a complex and dynamic environment. The author presents a role-playing simulation exercise which models ICU admission and discharge decision making. Designed for the class-room, the simulation engages a variety of ethical, managerial, and public policy issues including end-of-life decision making, triage, and rationing. The simulation is based on a sequence of scenarios or "decision rounds" delineating conditions in the ICU in terms of disposition of ICU patients, number of available ICU beds, prognoses of candidates for admission, and other physiological and organizational information. Students, playing the roles of attending physician, hospital administrator, nurse manager, triage officer, and ethics committee member, are challenged to reach consensus in the context of multiple power centers and conflicting goals. An organization theory perspective, incorporated into the simulation, provides insight on how decisions are actually made and stimulates discussion on how decision making might be improved.

Physicians as executives: boon or boondoggle?

It should come as no surprise to any observer of trends in the U.S. healthcare delivery system that physicians are taking a keener interest in the organization and management of that system. The practice of medicine has become, to a large degree, overtaken by events. Managed care and system integration have tended to place decision making at points further and further removed from patient care, the natural purview of the physician. It is to regain the initiative on how patient care is provided that physicians are moving in greater numbers into management. It is our contention that this move portends well for the future of the system. The unique advantage of the physician executive is the ability to bring to bear on healthcare management an understanding of the clinical processes that are its essential content. With strong clinical credentials and excellent management training, the physician is poised to make significant contributions to a healthcare organization's success.

Formulating the mess: lessons from "Building Knowledge of Health Care as a System".

This article describes the experiences of a group of health administration educators, a group of medical educators, and a group of nursing educators in applying the lessons of the exercise "Building Knowledge of Health Care as a System" to the organization of health professions education.

Graduate health administration field experiences: a university and health service delivery systems partnership.

The importance of experiential components of education to professional preparation has been evidenced in the curricula of academic institutions in several disciplines. Graduate programs in health administration offer a variety of alternative residency, internship, and other field experiences for students to apply academic theory to practical phenomena. Using a case study approach, this article presents the advantages of field experience options to both students and health care delivery sites. Components of a model of experiential alternatives in a graduate health administration program are described.

New curriculum challenges in health administration education.

Tradition curriculum content and structure in health administration education programs have focused on the managing of individual institutions, the business function, and the hospital as the center of the health system. These assumptions are challenged by managed care, with its orientation on integrating the business and clinical functions; prevention and primary care; and the provision of services through integrated service networks. The design and process of curriculum change in response to new organization structures and management challenges are explored.

Competencies for health management practice: a practitioner's perspective.

The current health care environment will require executive leadership with a new set of management competencies to effectively lead and manage the various components of a restructured health care delivery system. The traditional management skills of planning, organizing, directing, controlling, and staffing resources will remain relevant, but the true measure of professional success will be the development of conceptual skills. This means the ability to look at the health care enterprise as a whole, and recognize how changes in the environment shape your strategic mission, goals, and objectives. The successful health care leader will have a demonstrated ability to apply these conceptual skills to the development of information systems and integrated networks that position their organization to accept capitated risks. This paper examines the United States and Canadian health care systems from the perspective of both the more traditional hospital and the emerging medical care organizations. New importance of the team approach to leadership and management and all that entails is stressed.

A growth industry. Graduate programs in health care are expanding rapidly.

The debate of over health care reform is now front and center on the national stage. So this year, U.S. News has added four surveys of educational programs in health professions--health services administration, pharmacy, nursing and dentistry--to its study of America's Best Graduate Schools (tables, Page 79). Following, a brief report on enrollment trends in each area.

Management education at the Nordic School of Public Health.

This article introduces the Program of Health Services Management at the Nordic School of Public Health in Gothenburg, Sweden, after its reorganization in 1987. The school is a joint effort of the governments of Denmark, Finland, Norway, Iceland, and Sweden. As background, some research on the effects of management training for physicians and on the significance of leadership is presented. This article focuses on the relationship between administration, management, and leadership. The program aims at a holistic approach. The appendix presents the main purposes and content of the program.

Management education for medical students.

There is little doubt that the economics, management, and delivery of health care in the United States are currently in an unprecedented state of flux. Prospective payment, cost containment, and corporatization of health care delivery are rapidly replacing retrospective fee-for-service reimbursement and unmanaged provider practice patterns. Though ultimately certain to affect significantly physicians now in training, these changes have been afforded little attention in the undergraduate medical curriculum. At Hahnemann University, this is no longer the case. "Management Education for Medical Students" is an elective, intensive, eight-week experience for senior medical students. Following a thorough orientation to the workings of organizations through which health care is delivered, medical students receive both didactic and project-oriented instruction in university hospital administration during the first four weeks. During the course's second half, students are offered specialized training in the part of medical management that links the clinical and the financial aspects of health care management.

Implications for management in integrated health systems.

Leadership formulas cannot be tacked to an office wall for use. Leadership encompasses artistry and is a fluctuating, high tech, high touch activity. It must operate with fluidity and flexibility. Leaders must translate ethical issues in day-by-day operations by knowing the difference between right and wrong. The lines between the two are not always clear, but it is essential for the leader to clarify the issues in order for the team to function with the best interest of both the patient and the organization in mind. Executives operating within complex organizational structures need to focus carefully on these ethical and value systems, and it is the responsibility of educators to prepare students to understand these value issues. Once value systems are understood, it is easier to deal with organizational confrontation and control issues. The health system is changing, and educators and practitioners are also changing. A prescription for success includes a strong element of self-assessment that links personal and professional behavior to leadership. Leadership is the awareness of how one can positively affect the organization's change process and is the means that the individual uses to determine its direction and course. Leaders simply work harder at doing what they do best and by so doing, motivate others as well to achieve high levels of success and performance. If there is one characteristic that contributes most to the development of a leader both on campus and off, it is the commitment to a lifelong process of learning.(ABSTRACT TRUNCATED AT 250 WORDS)