RESUMO
OBJECTIVES: The Society of Critical Care Medicine convened its Academic Leaders in Critical Care Medicine taskforce on February 22, 2016, during the 45th Critical Care Congress to develop a series of consensus papers with toolkits for advancing critical care organizations in North America. The goal of this article is to propose a framework based on the expert opinions of critical care organization leaders and their responses to a survey, for current and future critical care organizations, and their leadership in the health system to design and implement successful regionalization for critical care in their regions. DATA SOURCES AND STUDY SELECTION: Members of the workgroup convened monthly via teleconference with the following objectives: to 1) develop and analyze a regionalization survey tool for 23 identified critical care organizations in the United States, 2) assemble relevant medical literature accessed using Medline search, 3) use a consensus of expert opinions to propose the framework, and 4) create groups to write the subsections and assemble the final product. DATA EXTRACTION AND SYNTHESIS: The most prevalent challenges for regionalization in critical care organizations remain a lack of a strong central authority to regulate and manage the system as well as a lack of necessary infrastructure, as described more than a decade ago. We provide a framework and outline a nontechnical approach that the health system and their critical care medicine leadership can adopt after considering their own structure, complexity, business operations, culture, and the relationships among their individual hospitals. Transforming the current state of regionalization into a coordinated, accountable system requires a critical assessment of administrative and clinical challenges and barriers. Systems thinking, business planning and control, and essential infrastructure development are critical for assisting critical care organizations. CONCLUSIONS: Under the value-based paradigm, the goals are operational efficiency and patient outcomes. Health systems that can align strategy and operations to assist the referral hospitals with implementing regionalization will be better positioned to regionalize critical care effectively.
Assuntos
Cuidados Críticos/organização & administração , Planejamento de Instituições de Saúde/organização & administração , Eficiência Organizacional , Humanos , Liderança , Encaminhamento e Consulta/organização & administração , Análise de Sistemas , Telemedicina/organização & administração , Resultado do Tratamento , Estados UnidosAssuntos
Cuidados Críticos/organização & administração , Equidade em Saúde/organização & administração , Planejamento de Instituições de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Cuidados Críticos/normas , Eficiência Organizacional , Humanos , Qualidade da Assistência à Saúde/normasRESUMO
Background: Planning a comprehensive program addressing neonatal mortality will require a detailed situational analysis of available neonatal-specific health infrastructure. Methods: We identified facilities providing essential and sick neonatal care (ENC, SNC) by a snowballing technique in Ballabgarh Block. These were assessed for infrastructure, human resource and equipment along with self-rated competency of the staff and compared with facility-based or population-based norms. Results: A total of 35 facilities providing ENC and 10 facilities for SNC were identified. ENC services were largely in the public-sector domain (68.5% of births) and were well distributed in the block. SNC burden was largely being borne by the private sector (66% of admissions), which was urban-based. The private sector and nurses reported lower competency especially for SNC. Only 53.9% of government facilities and 17.5% of private facilities had a fully equipped newborn care corner. Conclusions: Serious efforts to reduce neonatal mortality would require major capacity strengthening of the health system, including that of the private sector.
Assuntos
Competência Clínica , Atenção à Saúde/organização & administração , Planejamento de Instituições de Saúde/organização & administração , Pessoal de Saúde , Acessibilidade aos Serviços de Saúde , Mortalidade Infantil , Serviços de Saúde Materno-Infantil , Morte Perinatal/prevenção & controle , Atenção à Saúde/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Saúde PúblicaRESUMO
BACKGROUND: A joint initiative of existing senior care organizations, the municipality of Meyenburg and the state of Brandenburg was further developed by affiliation of an institute of the Brandenburg University of Technology Cottbus-Senftenberg (ABV) in cooperation with members of the architecture and social work departments in 2014. MATERIAL AND METHODS: A cooperative process between different players was central to create an appropriate structure of services for this region. RESULTS: Cooperative projects are necessary to establish new forms of generation-appropriate living and care concepts in rural areas. CONCLUSION: Cooperative learning methods are needed to develop new forms of generation-appropriate living and care concepts in rural areas, which take the diversity of elderly people, the rural context, intergenerational residential arrangements and affordable accommodation that meets the requirements of the social security system into account. Furthermore, the project had to reflect the recent developments of the German care insurance. The article describes the participatory methods, the coordination process and the resulting concept.
Assuntos
Planejamento de Instituições de Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Habitação para Idosos/organização & administração , Colaboração Intersetorial , Modelos Organizacionais , Serviços de Saúde Rural/organização & administração , AlemanhaAssuntos
Poluentes Atmosféricos , Mudança Climática/estatística & dados numéricos , Planejamento de Instituições de Saúde/organização & administração , Hospitais , Incineração/estatística & dados numéricos , Resíduos de Serviços de Saúde/estatística & dados numéricos , Monitoramento Ambiental , Planejamento de Instituições de Saúde/tendências , Pesquisa sobre Serviços de Saúde , HumanosRESUMO
As the vast repository of data about millions of patients grows, the analysis of this information is changing the provider-patient relationship and influencing the continuum of care for broad swaths of the population. At the same time, while population health management moves from a volume-based model to a value-based one and additional patients seek care due to healthcare reform, hospitals and healthcare networks are evaluating their business models and searching for new revenue streams. Utilizing geographical information systems to model and analyze large amounts of data is helping organizations better understand the characteristics of their patient population, demographic and socioeconomic trends, and shifts in the utilization of healthcare. In turn, organizations can more effectively conduct service line planning, strategic business plans, market growth strategies, and human resource planning. Healthcare organizations that use GIS modeling can set themselves apart by making more informed and objective business strategy decisions.
Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Sistemas de Informação Geográfica/organização & administração , Marketing de Serviços de Saúde/organização & administração , Relações Médico-Paciente , Prestação Integrada de Cuidados de Saúde/organização & administração , Demografia , Reforma dos Serviços de Saúde , Planejamento de Instituições de Saúde/organização & administração , Humanos , Satisfação do Paciente , Estados UnidosRESUMO
In healthcare a significant portion of the budget is related to human resources. However, many healthcare organizations have yet to develop and implement a focused organizational strategy that ensures all human resources are managed in a way that best supports the successful achievement of corporate strategies. St. Michael's Hospital, in Toronto, Ontario, recognized the benefits of a strategic human resources management plan. During an eight-month planning process, St. Michael's Hospital undertook the planning for and development of a strategic human resources management plan. Key learnings are outlined in this paper.
Assuntos
Planejamento de Instituições de Saúde/organização & administração , Mão de Obra em Saúde/organização & administração , Administração Hospitalar/métodos , Hospitais , Ontário , Inovação Organizacional , Objetivos Organizacionais , Gestão de Recursos Humanos/métodosAssuntos
Doença de Alzheimer/enfermagem , Doença Crônica/enfermagem , Comunicação Interdisciplinar , Colaboração Intersetorial , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Idoso , Planejamento de Instituições de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Enfermagem em Reabilitação/organização & administraçãoRESUMO
This document was developed by the members of the Committee to Revise the Guidelines for Services, Personnel, and Facilities at Specialized Epilepsy Centers. After discussions with the general membership they were adopted by the Board of the National Association of Epilepsy Centers. The Guidelines will be reviewed and updated when considered necessary by the Board.
Assuntos
Epilepsia/diagnóstico , Epilepsia/terapia , Planejamento de Instituições de Saúde/organização & administração , Diretrizes para o Planejamento em Saúde , Hospitais Especializados/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Comportamento Cooperativo , Arquitetura de Instituições de Saúde/métodos , Humanos , Comunicação Interdisciplinar , Estados UnidosRESUMO
This article reports the findings of one county's human service network's readiness to treat gambling related problems in anticipation of the opening of a new casino. Using a cross-sectional survey design, questionnaires were mailed to executive directors of all mental health, family counseling, drug and alcohol, and faith-based, addiction-related organizations in the county (N = 248); 137 (55.2%) agency directors responded to the questionnaire. The survey requested information about agency demographics, training, screening, treatment, and public awareness/education. Descriptive statistics and bivariate analyses were used to summarize the findings. The analyses revealed a lack of human service response to the impending start of casino gambling. More than three-quarters of respondents had not sent staff for training in screening or treating gambling disorders, did not screen for problem gambling, did not treat problem gambling, and did not refer clients to other agencies for treatment of gambling-related problems. The most common reason offered for not engaging in prevention and treatment activities was that problem gambling is not considered an issue for the agency. There were differences between mental health and/or substance abuse focused agencies and other service providers. Based on the findings of this study, specific strategies to enhance the service delivery network's capacity to address problem gambling are suggested.
Assuntos
Centros Comunitários de Saúde/organização & administração , Transtornos Disruptivos, de Controle do Impulso e da Conduta/terapia , Jogo de Azar/terapia , Planejamento de Instituições de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania , Padrões de Prática Médica , Administração em Saúde PúblicaRESUMO
PURPOSE: Guidance on alternate care site planning based on the experience of a health-system pharmacy department in preparing for an expected surge in coronavirus disease 2019 (COVID-19) cases is provided. SUMMARY: In disaster response situations such as the COVID-19 pandemic, healthcare institutions may be compelled to transition to a contingency care model in which staffing and supply levels are no longer consistent with daily practice norms and, while usual patient care practices are maintained, establishment of alternate care sites (eg, a convention center) may be necessitated by high patient volumes. Available resources to assist hospitals and health systems in alternate care site planning include online guidance posted within the COVID-19 resources section of the US Army Corps of Engineers website, which provides recommended medication and supply lists; and the Federal Healthcare Resilience Task Force's alternate care site toolkit, a comprehensive resource for all aspects of alternate care site planning, including pharmacy services. Important pharmacy planning issues include security and storage of drugs, state board of pharmacy and Drug Enforcement Administration licensing considerations, and staff credentialing, education, and training. Key medication management issues to be addressed in alternate site care planning include logistical challenges of supply chain maintenance, optimal workflow for compounded sterile preparations (eg, on-site preparation vs off-site preparation and delivery from a nearby hospital), and infusion pump availability and suitability to patient acuity levels. CONCLUSION: Planning for and operation of alternate care sites in disaster response situations should include involvement of pharmacists in key decision-making processes at the earliest planning stages.
Assuntos
Tratamento Farmacológico da COVID-19 , Tomada de Decisões Gerenciais , Planejamento em Desastres/organização & administração , Planejamento de Instituições de Saúde/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , COVID-19/epidemiologia , Emergências , Planejamento de Instituições de Saúde/normas , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Conduta do Tratamento Medicamentoso/organização & administração , Modelos Organizacionais , Pandemias/prevenção & controle , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/normas , Guias de Prática Clínica como Assunto , Fluxo de TrabalhoAssuntos
Serviço Hospitalar de Emergência/normas , Planejamento de Instituições de Saúde/normas , Emergências , Serviço Hospitalar de Emergência/organização & administração , Planejamento de Instituições de Saúde/organização & administração , Humanos , Alocação de Recursos/organização & administração , Alocação de Recursos/normasAssuntos
Arquitetura de Instituições de Saúde/métodos , Planejamento de Instituições de Saúde/organização & administração , Materiais de Construção/economia , Materiais de Construção/normas , Eficiência Organizacional , Arquitetura de Instituições de Saúde/economia , Arquitetura de Instituições de Saúde/tendências , Planejamento de Instituições de Saúde/economia , Planejamento de Instituições de Saúde/normas , HumanosRESUMO
SETTING: County tuberculosis (TB) dispensaries are the basic health care unit for the provision of TB services in China. In the rural hills of the western provinces of China, however, county centres are often far from patients' homes. OBJECTIVE: To evaluate whether decentralisation would result in improvements in patient access to TB services while maintaining the quality of the DOTS strategy. METHODS: The present study compared TB services that were decentralised to township hospitals with two comparable control groups where township hospitals continued to routinely refer suspects to the county TB dispensaries. Training and supervision of quality control were provided. Routine TB reporting data were reviewed. A questionnaire-based survey was conducted for 171 new TB patients enrolled from 1 April 2005 to 31 July 2006. RESULTS: Patients in the decentralised group spent less on travel and treatment for TB. The TB case notification rates increased significantly in the decentralised group, but remained unchanged in the control groups. Compared with the control groups, the decentralised group had improved treatment outcomes after 16 months. A higher quality of care was also observed in the decentralised group. CONCLUSION: The decentralised model showed better patient access and quality of care. The study demonstrated that decentralising TB services to the township level, especially vital in China's poorly accessible areas, was feasible.
Assuntos
Serviços de Saúde Comunitária/organização & administração , Terapia Diretamente Observada , Planejamento de Instituições de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde , Tuberculose/terapia , China , Notificação de Doenças/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Política , Resultado do Tratamento , Tuberculose/tratamento farmacológicoAssuntos
Organizações de Assistência Responsáveis/normas , Doença Crônica/terapia , Planejamento de Instituições de Saúde/organização & administração , Promoção da Saúde/normas , Ambulatório Hospitalar/tendências , Organizações de Assistência Responsáveis/organização & administração , Doença Crônica/prevenção & controle , Planejamento de Instituições de Saúde/normas , Planejamento de Instituições de Saúde/tendências , Promoção da Saúde/tendências , Humanos , Patient Protection and Affordable Care Act/normas , Estados UnidosAssuntos
Planejamento de Instituições de Saúde/economia , Parcerias Público-Privadas/economia , Medicina Estatal/organização & administração , Planejamento de Instituições de Saúde/organização & administração , Planejamento de Instituições de Saúde/normas , Humanos , Medicina Estatal/normas , Reino UnidoRESUMO
The transition of leadership within radiology practices is often not a planned replacement process with formal development of potential future leaders. To ensure their ongoing success, however, practices need to develop comprehensive succession plans that include a robust developmental program for potential leaders consisting of mentoring, coaching, structured socialization, 360-degree feedback, developmental stretch assignments, job rotation, and formal education. Succession planning and leadership development will be necessary in the future for a practice to be successful in its business relationships and to be financially viable.
Assuntos
Planejamento de Instituições de Saúde/organização & administração , Liderança , Tutoria/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Administração da Prática Médica/organização & administração , Radiologia/organização & administração , Previsões , Modelos Organizacionais , Objetivos Organizacionais , Prática Privada/organização & administração , Desenvolvimento de Programas/métodos , Desenvolvimento de Pessoal/organização & administração , Estados UnidosRESUMO
Determining staff and space requirements for military medical centers can be challenging. Changing patient populations change the caseload requirements. Deployment and assignment rotations change the experience and education of clinicians and support staff, thereby changing the caseload capacity of a facility. During wartime, planning becomes increasingly more complex. What will the patient mix and caseload volume be by location? What type of clinicians will be available and when? How many beds are needed at each facility to meet caseload demand and match clinician supply? As soon as these factors are known, operations are likely to change and planning factors quickly become inaccurate. Soon, more beds or staff are needed in certain locations to meet caseload demand while other locations retain underutilized staff, waiting for additional caseload fluctuations. This type of complexity challenges the best commanders. As in so many other industries, supply and demand principles apply to military health, but very little is stable about military health capacity planning. Planning analysts build complex statistical forecasting models to predict caseload based on historical patterns. These capacity planning techniques work best in stable repeatable processes where caseload and staffing resources remain constant over a long period of time. Variability must be simplified to predict complex operations. This is counterintuitive to the majority of capacity planners who believe more data drives better answers. When the best predictor of future needs is not historical patterns, traditional capacity planning does not work. Rather, simplified estimation techniques coupled with frequent calibration adjustments to account for environmental changes will create the most accurate and most useful capacity planning and management system. The method presented in this article outlines the capacity planning approach used to actively manage hospital staff and space during Operations Iraqi Freedom and Enduring Freedom.
Assuntos
Planejamento de Instituições de Saúde/métodos , Recursos em Saúde/provisão & distribuição , Planejamento Hospitalar/organização & administração , Corpo Clínico Hospitalar/provisão & distribuição , Planejamento de Instituições de Saúde/organização & administração , Humanos , Avaliação das NecessidadesRESUMO
No disponible
Assuntos
Humanos , Assistência Centrada no Paciente/organização & administração , Educação Médica/tendências , Competência Clínica , Infecções por Coronavirus/epidemiologia , Pandemias/prevenção & controle , Planejamento de Instituições de Saúde/organização & administração , Padrões de Prática Médica/tendênciasRESUMO
The purpose of this article was to discuss the process of setting up a nuchal translucency (NT) screening clinic in clinical practice, how to interpret the information in combination with other clinical tests, what to do if abnormal results are obtained, and to illustrate some of the fetal anomalies that are associated with an increased NT. The NT was initially implemented to predict the likelihood of a fetus with Down syndrome. Maternal age can be combined with fetal NT and maternal serum biochemistry (free ß-hCG and PAPP-A) at 11 to 14 weeks to identify about 90% of affected fetuses. Setting up a clinic to perform the NT screening requires certified physicians and certified sonographers. Certification can be obtained for both physicians and sonographers through Nuchal Translucency Quality Review and Fetal Medicine Foundation. Cell-free DNA testing is now altering what our patients are choosing to evaluate fetuses at risk for chromosomal anomalies and congenital anomalies. Common pitfalls to performing, interpreting, and conveying results of the NT are illustrated in this article. Nasal bone measurement, fetal anatomy examination and fetal echocardiography are tools that add sensitivity to the detection of chromosomal abnormalities. Examples of fetal anomalies discovered during the NT screening are also illustrated. Screening for obstetric complications is an additional benefit to the NT clinic.