Hospital-Level Cardiovascular Management Practices in Kerala, India.

Background Hospital management practices are associated with cardiovascular process of care measures and patient outcomes. However, management practices related to acute cardiac care in India has not been studied. Methods and Results We measured management practices through semistructured, in-person interviews with hospital administrators, physician managers, and nurse managers in Kerala, India between October and November 2017 using the adapted World Management Survey. Trained interviewers independently scored management interview responses (range: 1-5) to capture management practices ranging from performance data tracking to setting targets. We performed univariate regression analyses to assess the relationship between hospital-level factors and management practices. Using Pearson correlation coefficients and mixed-effect logistic regression models, we explored the relationship between management practices and 30-day major adverse cardiovascular events defined as all-cause mortality, reinfarction, stroke, or major bleeding. Ninety managers from 37 hospitals participated. We found suboptimal management practices across 3 management levels (mean [SD]: 2.1 [0.5], 2.0 [0.3], and 1.9 [0.3] for hospital administrators, physician managers, and nurse managers, respectively [ P=0.08]) with lowest scores related to setting organizational targets. Hospitals with existing healthcare quality accreditation, more cardiologists, and private ownership were associated with higher management scores. In our exploratory analysis, higher physician management practice scores related to operation, performance, and target management were correlated with lower 30-day major adverse cardiovascular event. Conclusions Management practices related to acute cardiac care in participating Kerala hospitals were suboptimal but were correlated with clinical outcomes. We identified opportunities to strengthen nonclinical practices to improve patient care.

The medical director in integrated clinical care models.

Integrated clinical care models, like Accountable Care Organizations and ESRD Seamless Care Organizations, present new opportunities for dialysis facility medical directors to affect changes in care that result in improved patient outcomes. Currently, there is little scholarly information on what role the medical director should play. In this opinion-based review, it is predicted that dialysis providers, the hospitals in which the medical director and staff physicians practice, and the payers with which they contract are going to insist that, as care becomes more integrated, dialysis facility medical directors participate in new ways to improve quality and decrease the costs of care. Six broad areas are proposed where dialysis unit medical directors can have the greatest effect on shifting the quality-care paradigm where integrated care models are used. The medical director will need to develop an awareness of the regional medical care delivery system, collect and analyze actionable data, determine patient outcomes to be targeted that are mutually agreed on by participating physicians and institutions, develop processes of care that result in improved patient outcomes, and lead and inform the medical staff. Three practical examples of patient-centered, quality-focused programs developed and implemented by dialysis unit medical directors and their practice partners that targeted dialysis access, modality choice, and fluid volume management are presented. Medical directors are encouraged to move beyond traditional roles and embrace responsibilities associated with integrated care.

[Surgery and management: natural partners]. / Chirurgie und Management: natürliche Partner.

The term management is a description of the functions: planning, organization, leadership and control in institutions and the corresponding persons holding these powers. In order to efficiently lead a department of surgery, surgeons need to possess management qualities and have to be able to act as team leaders. Good management of a surgical department leads to avoidance of complications and increased profits as well as more efficient use of operating room capacities and a better organization within the department.

[A bit of business administration--no problem for physicians: Master of Business Administration as panacea?]. / Das bisschen Betriebswirtschaft - für Arzte kein Problem : Der Master of Business Administration als Wundermittel?

Medical professionals with additional economic qualifications are in high demand. For doctors who aim for leading positions at medical institutions the most popular additional qualification is a Master of Business Administration (MBA). The demands on executive managers in hospitals have without any doubt changed in recent years requiring them to be trained in basic economic understanding, human resource management etc. in addition to having excellent medical training. However, MBA programs differ from one academic institution to the next. Due to the lack of standardized schedules in MBA programs it cannot be ascertained whether a candidate received adequate training and can offer the skills necessary for a higher level medical profession. In this paper the author suggests that specific training in individually required skills would be more reasonable and effective rather than encouraging medical staff to pursue academic studies leading to an MBA.

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

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

Incorporating a medical spa into a physician-run practice.

The age-old spa concept is no less valuable today than it was during the time of Julius Caesar. Over the centuries, there have been many iterations of the concept of the spa. The most recent is the medical spa, which has become the fastest-growing segment of the spa industry. Many physicians including dermatologists wish to incorporate a medical spa into their practices. This article discusses the key elements that should be considered to make this venture successful.

Supervising music therapy interns: a survey of AMTA national roster internship directors.

Music therapy internship directors provide supervision to interns during a critical phase in their educational process. Although the American Music Therapy Association provides guidelines for this role, little is known about the supervision practices currently being employed. In order to investigate these practices, a mailed survey was sent to all current national roster internship directors. This descriptive research project gathered information related to demographics, education and training, techniques, roles, challenges, and rewards. Results suggest that internship directors represent diverse demographics, clinical populations, and experience levels. They have advanced levels of education and experience but desire further training in supervision. A wide variety of supervisory techniques are employed, with coleading, live observation, and reviewing assignments being the most frequently utilized. Internship directors feel they hold many responsibilities and report high levels of enjoyment in their roles. Results are compared to previous studies and implications of providing further training to internship directors are explored. Recommendations for future research include the addition of university-affiliated internship programs.

Impact of primary care management on nursing documentation.

AIM: The aim was to investigate whether perceptions of electronic nursing documentation and its performance differed because of primary health care management. BACKGROUND: Success in leading people depends on the manager's personality, the context and the people who are led. Close proximity to clinical work, with manager and personnel sharing the same profession, promotes the authority to carry out changes. METHODS: This study comprised a postal questionnaire to district nurses and an audit of nursing records from two primary health care organizations, one with a uniprofessional (nursing) organization, and one with multidisciplinary health care centres with general practitioners and/or another profession as managers. RESULTS: Uniprofessional nurse management increased district nurses' positive perceptions of nursing documentation but did not affect documentation performance, which was inadequate regardless of management type. CONCLUSIONS: Positive perceptions of nursing documentation are bases for further development to a nursing documentation including a holistic view of the patient.

Paying physicians for quality: evidence and themes from the field.

BACKGROUND: Health plans, self-insured employers, health plans, and provider organizations are currently introducing financial incentives that reward physicians for delivering high-quality medical care. Yet a review of existing research reveals virtually no empirical studies of the effect of direct, internal quality incentives on physician performance. Key-informant interviews with leaders of provider organizations should shed new light on evolving quality incentives within organizations. METHODS: Structured key-informant interviews with administrators and medical directors in 22 medical groups and 9 hospitals affiliated with 10 large, integrated health systems were conducted from July 2003 through January 2004. FINDINGS: Views on the role of financial incentives varied widely and were related to a number of other factors, including institutional culture, community context, organizational strategy and structure, organizational stability, quality measurement, nature and size of incentives, and the sustainability of interventions. DISCUSSION: These findings have implications for the acceptability and structure of financial incentives for quality directed to health care provider organizations. A set of considerations for the design and implementation of quality incentives relate to the incentives' scope, controllability, transparency, size, and orientation (individual or team), as well as the relationship between the extrinsic financial incentives and professionals' intrinsic motivation.

A quality improvement study on calcium and vitamin D supplementation in long-term care.

OBJECTIVES: The objectives of this study were to evaluate the impact of a quality improvement (QI) study on improving calcium and vitamin D supplementation in a long-term care setting. DESIGN: Retrospective chart review. SETTING: An academic long-term care facility that specializes in dementia care in St Louis, MO. PARTICIPANTS: Participants consisted of 83 long-term care residents. INTERVENTION: The quality improvement team created an educational letter that was signed by the medical director and sent to the facilities' primary care physicians. This letter provided clinicians with the rationale and method to achieve adequate calcium supplementation, assess vitamin D status, and provide adequate vitamin D supplementation in our long-term care setting. Following the letter, the facility pharmacist reviewed the orders during monthly medication reviews and faxed requests to the primary care physicians for appropriate supplements or laboratory tests when necessary. MEASUREMENTS: We reviewed the charts for the presence of calcium supplementation orders, vitamin D levels, and vitamin D supplementation before and after our QI intervention. RESULTS: Of the 83 resident charts that were reviewed, only 37 (44.6%) had calcium supplementation, 19 (22.8%) had assessment of their vitamin D status, and 29 (34.9%) had ongoing vitamin D supplementation prior to implementation of the study. After the QI intervention, calcium supplementation was present in 66 residents (79.5%), vitamin D status had been assessed in 61 residents (73.4%), and vitamin D supplementation had been initiated in 65 residents (78.3%). These changes were statistically significant (P < .05). CONCLUSION: A quality improvement project that used an educational letter from the medical director combined with a medication and laboratory review by the pharmacist was able to increase the number of residents in our long-term care setting with calcium supplementation, increase the number of residents who had vitamin D status assessed, identify many residents with low vitamin D levels, and increase supplementation of vitamin D when indicated.