Keeping an eye on at-risk patients remotely.

Sitter pay ranges from $11 to $40 an hour, while the cost to use AvaSure is under $3 an hour per patient, Brad Playford said.

Psychiatry Departments Under Constrained Funding Mechanisms or What Is a Chairperson to Do?

OBJECTIVE: The authors surveyed academic departments of psychiatry to examine what effect decreases in funding levels may be having. METHODS: An internet survey of all departments of psychiatry was conducted at US medical schools. The response rate was 43 of 120 programs. Both large more research intensive and smaller more clinical departments responded. RESULTS: Majorities of departments reported that funding decreases negatively impacted faculty recruitment, research, faculty retention, and teaching programs. Approximately, one-third reported laying-off non-tenured faculty members and almost half, staff members. Graduate Medical Education (GME) funding was also a challenge. Departments reported responding by attempting to develop alternative funding sources. Few departments in the sample were doing significant fund raising. CONCLUSIONS: Academic departments find themselves stressed financially and are constricting some functions that are thought important. They are, in general, not able to replace lost funding. The research enterprise appears to be disproportionately affected and results in problems recruiting faculty. GME programs thus far seem less affected. Overall, funding issues appear to be causing serious issues that will have long-term consequences.

Financial crisis and collapsed banks: psychological distress and work related factors among surviving employees--a nation-wide study.

AIM: The study considered psychological distress among surviving bank employees differently entangled in downsizing and restructuring following the financial crisis of 2008. METHODS: A cross-sectional, nationwide study was conducted among surviving employees (N = 1880, response rate 68%). Multivariate analysis was conducted to assess factors associated with psychological distress. RESULTS: In the banks, where all employees experienced rapid and unpredictable organizational changes, psychological distress was higher among employees most entangled in the downsizing and restructuring process. Being subjected to downsizing within own department, salary cut, and transfer to another department, was directly related to increased psychological distress, controlling for background factors. The associations between downsizing, restructuring, and distress were reduced somewhat by adding job demands, job control, and empowering leadership to the model, however, adding social support had little effect on these associations. CONCLUSION: Employees most entangled in organizational changes are the most vulnerable and should be prioritized in workplace interventions during organizational changes.

An evaluation of a sitter reduction program intervention.

Hospitals use sitters as an alternative to reduce patient falls. The purpose of the study was to evaluate the effectiveness of a sitter reduction program by examining the differences between sitter use and falls in an acute care hospital. Findings indicate that a significant decrease in sitter use and falls remained constant. Reducing sitter use is possible without significantly increasing fall rates.

Doing the math. Groups say the debt-ceiling law's $11.1 billion hit to Medicare would lead to mass layoffs in healthcare.

As Washington wrestles with looming mandatory cuts forced by a deficit agreement, the AMA, AHA and ANA are warning of massive job cuts. "If I've got a choice of maintaining these beneficial programs or contract them for my core mission, you're going to choose your core mission. And that will cost the community more in terms of health and of dollars," says Rich Morrison, of Adventist Health System.

Create a translational medicine knowledge repository--research downsizing, mergers and increased outsourcing have reduced the depth of in-house translational medicine expertise and institutional memory at many pharmaceutical and biotech companies: how will they avoid relearning old lessons?

Pharmaceutical industry consolidation and overall research downsizing threatens the ability of companies to benefit from their previous investments in translational research as key leaders with the most knowledge of the successful use of biomarkers and translational pharmacology models are laid off or accept their severance packages. Two recently published books may help to preserve this type of knowledge but much of this type of information is not in the public domain. Here we propose the creation of a translational medicine knowledge repository where companies can submit their translational research data and access similar data from other companies in a precompetitive environment. This searchable repository would become an invaluable resource for translational scientists and drug developers that could speed and reduce the cost of new drug development.

[Personnel reduction in clinics and legal responsibility]. / Personalabbau in der Klinik und rechtliche Verantwortung : Personnel reduction in clinics and legal responsibility.

Executive clinical physicians are increasingly being made jointly responsible for the economic success of clinics and it is to be expected that this joint responsibility will result in measures to reduce personnel. In this article it will be explained to which limits a reduction in medical personnel can be justified with respect to liability and from what level a reduction in staff can result in forensic risks. Furthermore, it will be discussed which liability or even penal responsibility in this connection affects the physicians, the hospital and especially the senior medical personnel.

Saving it for later. Healthy hospitals turn to layoffs to bend own cost curve.

When the credit crisis hit in 2008, many hospitals reacted by cutting staff. While credit access and the markets may have rebounded, hospital spending hasn't and some are still looking for cuts. Dennis Dahlen, of Banner Health, recently told the health system's investors that executives will "plan for the worst and work for the best."

Surgical, Economic, and Psychological Impacts of SARS-COV-2 on a Kansas Community Hospital System.

The chief of surgery of a 264-bed acute care facility and clinic system in Topeka, KS, USA, gives a chronology that illustrates the rapid and profound clinical, economic, and emotional impact of the SARS-CoV-2 outbreak on his hospital and community. In his view, the pandemic has laid bare the weaknesses of several factors basic to the modern US health care system and the resulting economic crisis: just-in-time supply chain technology; foreign sourcing of masks, gowns, and critical equipment, all at critical shortages during the crisis; rural hospital closings; lack of excess capacity through maximization of utilization for efficiency; and an overreliance on high revenue elective procedures and tests. His team was tested by an emergency operation for bowel obstruction that put all the isolation protocols into action. Despite their readiness and the success of the operation and the potential for telemedicine as an alternative to in-person evaluations and outpatient visits, the forced cancellation of all elective operations have led to the loss of revenue for both hospital system and providers, furlough and termination of workers, and financial hardship and uncertainty.

The economic crisis and primary health care in the SUS of Rio de Janeiro, Brazil. / A crise econômica e a atenção primária à saúde no SUS da cidade do Rio de Janeiro, Brasil.

This paper addresses the primary health care crisis of Rio de Janeiro public health system as of 2018. This municipality has experienced a robust primary care expansion since 2009, adopting Social Organizations for recruiting professionals and managing services, qualifying the infrastructure of units and prioritizing family and community medicine, as well as adopting management practices such as standardized offers, evaluation and pay-for-performance compensation, marketing, among others. Given the recent economic crisis, the municipal manager decided to reduce family health teams, considering the current National Policy of Primary Care and arguing that it is possible to optimize resources (doing more with less). In this process, he faced resistance that was not enough to stop him. Due to the resonance of this city (second largest in Brazil and prominent in the national press) and based on public documents and formulations on management, the crisis expressed in the primary health care of this city was debated around the implications of the adoption of Social Organizations in the sustainability of health services, conducting management processes and their rationalities, as well as the political action of social agents advocating for the SUS and primary care in particular.

Este artigo aborda a crise na atenção primária à saúde do sistema público de saúde da cidade do Rio de Janeiro, a partir de 2018. Tal município teve forte expansão da atenção primária desde 2009, adotando Organizações Sociais para a contratação de profissionais e gerenciamento dos serviços, qualificando a infraestrutura das unidades e priorizando a medicina de família e comunidade, além de adotar práticas gerenciais como normatizações de ofertas, avaliação e remuneração por desempenho, "marketing", dentre outras. Diante da recente crise econômica, a decisão do gestor municipal foi de reduzir equipes de saúde da família, considerando a atual Política Nacional de Atenção Básica e argumentando ser possível otimizar recursos (fazendo mais com menos). Neste processo, enfrentou resistências, que não foram suficientes para freá-lo. Pela ressonância desta cidade (segunda maior do Brasil e com destaque na imprensa nacional) e tomando como base documentos públicos e formulações sobre a gestão, a crise expressa na atenção básica deste município foi problematizada em torno das implicações da adoção de Organizações Sociais na sustentabilidade dos serviços, da condução dos processos de gestão e suas racionalidades bem como da atuação política de agentes sociais em defesa do SUS e da atenção primária em particular.

Organisational downsizing as a predictor of disability pension: the 10-town prospective cohort study.

OBJECTIVE: To examine whether downsizing, the reduction of personnel in organisations, is a predictor of increased risk of disability retirement among employees who kept their jobs. DESIGN: Prospective cohort study. Based on reductions of personnel in participants' occupation and workplace, employees were grouped into exposure categories of no downsizing (less than 8% reduction), minor downsizing (reduction between 8% and 18%), and major downsizing (more than 18% reduction). They were followed up for a five year period after downsizing. SETTING: Four towns in Finland. PARTICIPANTS: 19 273 municipal employees, aged 21-54 years. MAIN OUTCOME MEASURES: All permanent full disability pensions granted because of medical reasons below 55 years of age between 1 January 1994 and 31 December 1998 from the national registers. RESULTS: In all, 223 employees were granted a permanent disability pension. The overall rate for disability pensions per 1000 employees was 7.7 after no downsizing, 13.1 after minor downsizing, and 14.9 after major downsizing. Cox proportional hazard models adjusted for age, sex, occupational status, type of employment contract, and town showed 1.81 (95% confidence intervals 1.22 to 2.70) times higher risk of disability retirement after major downsizing than after no downsizing. CONCLUSIONS: The immediate financial advantages of downsizing need to be considered in relation to increased occupational disability and the resulting extra costs to employers and society.