Managing health care quality.

Using the cited principles of professional staff credentialing and quality assurance, a department chairman, medical director, or other health care executive will be in an excellent position to assess quality of care against established standards and manage problems in the routine provision of medically appropriate care. He or she will also be able to assure the hospital's board that the hospital and its medical staff are well positioned to meet future challenges to provide effective quality, utilization, and risk management.     

A Review of Procedural Acceptability in Organizational Behavior Management

ABSTRACT

Despite the documented benefits Organizational Behavior Management (OBM) applications can have on service provision for people with developmental disabilities, OBM is not widely practiced in service systems. One variable that may impact the utilization of OBM is how acceptable the associated procedures are to staff. The research on procedural acceptability in OBM is summarized in terms of two primary methods for determining consumer satisfaction with management procedures-rating scales and discrete choices. Results of acceptability assessments utilizing ratings scales have repeatedly indicated high degrees of staff acceptance for virtually all OBM procedures. However, when staff have been asked to choose among management procedures, clear and consistent differences in acceptability have been apparent. Suggested directions for future research focus on improving acceptability assessment methodology, developing guidelines for implementing effective OBM procedures in a manner that is most acceptable to staff, and involving supervisory and professional staff in acceptability evaluations.     

Organizational Behavior Management

ABSTRACT

Organizational behavior management (OBM) is an effective strategy for managing staff in developmental disabilities. Most studies in OBM involve individual or small groups of direct-service staff and their performance with clients in a variety of applied settings. By contrast, few studies focus on the use of OBM with professional staff. This papeT reviews investigations conducted with professional staff, reveals gaps that exist in the current research, and discusses future directions that need further study. The paper concludes with case illustrations of system-wide OBM applications that produced performance improvements by professional staff and meaningful gains for clients.     

A management strategy for information processing. 3—Management information requirements

In this, the third and final article in this series, the author examines the need for management to have access to ‘computing facilities’. He considers a middle road between the exercise of control and the flexible use of personal computers, and attempts to structure the basic needs of managers and professional staff for information Technology in its wider sense.     

Zur Integration ehrenamticher Mitarbeiter/innen in Organisationen

The integration of volunteers in organizations On the background of the current changes in the general work conditions, a professional volunteer management in organizations is necessary. The author demonstrates, that in organizations a professional staff with management competences is a precondition. The peculiarities in leading volunteers are explained. The focus of the article are suggestions to a personnel development, in order to instruct and to attend individual employees or larger organizational units for a successful cooperation with volunteers. A special training as well as coaching and organizational development are delineated.     

Boards want leadership and decisiveness.

Regardless of whether they aspire to the top executive spot, physician managers are likely to benefit from insights into what hospital boards want in their chief executive officers. Many of the attributes board chairs desire in hospital CEOs involve how they handle medical staff matters. In general, board chairs want leadership and decisiveness--attributes they likely would covetin any physician manager who has hospital management responsibilities.     

Stress management can lead to reduced malpractice.

The prevention of medical malpractice is not an easy task. There is no one factor that can be said to be the "cause" of malpractice claims. Many areas have been targeted for concern--interaction between an individual professional and the patient, interaction among members of the professional staff, use and outcome of the application of medical technology, management practices, occupational environment, level of education and training, and personal coping styles. Although the degree to which attention to stress management techniques can be expected to reduce malpractice claims is unclear, it seems certain that attempts to alleviate occupational stress would be productive.     

Occupational stress in universities: staff perceptions of the causes, consequences and moderators of stress

In recent years, the Australian university sector has undergone large-scale organizational change, including restructuring, downsizing and government funding cuts. At the same time, research from across the globe reports an alarming increase in the occupational stress experienced by university staff. We report on the first phase of a longitudinal investigation of occupational stress. A total of 22 focus groups were conducted with a representative sample of 178 academic and general staff from 15 Australian universities. The groups focused on understanding staff 's experience of occupational stress, and perceptions of the sources, consequences and moderators of stress. Both general and academic staff reported a dramatic increase in stress during the previous 5 years. As a group, academic staff reported higher levels of stress than general staff. Five major sources of stress were identified including: insufficient funding and resources; work overload; poor management practice; job insecurity; and insufficient recognition and reward. The majority of groups reported that job-related stress was having a deleterious impact on their professional work and personal welfare. Aspects of the work environment (support from co-workers and management, recognition and achievement, high morale, flexible working conditions), and personal coping strategies (stress management techniques, work/ non-work balance, tight role boundaries and lowering standards), were reported to help staff cope with stress. The findings provide a timely insight into the experience of stress within universities.     

Sometimes we're our own worst enemies

There is a sense of frustration among physicians involved in the decision and policy making processes within health care institutions. Because the endpoint is reached at glacial speed, too much time, money, and opportunity is lost. The decision making process can be repetitious and tedious because of unnecessary steps. By eliminating certain tactics and strategies employed by upper-level management in many health care institutions, the decision making process becomes more effective. This article focuses on the medical staff's role in the decision making process; explains why tactics to involve the medical staff are ineffective and why eliminating the medical staff from certain aspects of the process does not jeopardize the institution; and concludes that the hospital board and its delegates should be autonomous in the decision making process.     

Occupational stress in universities: Staff perceptions of the causes,consequences and moderators of stress

In recent years, the Australian university sector has undergone large-scale organizational change, including restructuring, downsizing and government funding cuts. At the same time, research from across the globe reports an alarming increase in the occupational stress experienced by university staff. We report on the first phase of a longitudinal investigation of occupational stress. A total of 22 focus groups were conducted with a representative sample of 178 academic and general staff from 15 Australian universities. The groups focused on understanding staff 's experience of occupational stress, and perceptions of the sources, consequences and moderators of stress. Both general and academic staff reported a dramatic increase in stress during the previous 5 years. As a group, academic staff reported higher levels of stress than general staff. Five major sources of stress were identified including: insufficient funding and resources; work overload; poor management practice; job insecurity; and insufficient recognition and reward. The majority of groups reported that job-related stress was having a deleterious impact on their professional work and personal welfare. Aspects of the work environment (support from co-workers and management, recognition and achievement, high morale, flexible working conditions), and personal coping strategies (stress management techniques, work/ non-work balance, tight role boundaries and lowering standards), were reported to help staff cope with stress. The findings provide a timely insight into the experience of stress within universities.     

Patterns of Profit-sharing in Professional Firms

In recent years the traditional method of distributing profits on the basis of seniority in professional firms has come under attack because of its poor incentive properties. Using data on large law firms, this paper examines the extent to which new forms of profit-sharing based on individual performance have been introduced and whether these are associated with the more systematic control of the core of professional staff and more ‘business-like’ methods of managing, as has been argued in the American literature. The results suggest profit-sharing innovations are limited in scope and only loosely associated with wider changes in partnership management. Explanations for the persistence of traditional methods of sharing are developed from the data and it is argued that existing accounts present an over-rational model of change in which too much emphasis has been placed on the importance of individual incentives to achieve performance. Profit-sharing policies are driven by concerns to sustain cooperation and professional values about the appropriate way to distribute rewards.     

Learning and Organization in the Knowledge‐Based Information Economy: Initial Findings from a Participatory Action Research Case Study

This paper reports on an ongoing, multiphase, project‐based action learning and research project. In particular, it summarizes some aspects of the learning climate and outcomes for a case‐study company in the software industry. Using a participatory action research approach, the learning company framework developed by Pedler et al. (1997) is used to initiate critical reflection in the company at three levels: managing director, senior management team and technical and professional staff. As such, this is one of the first systematic attempts to apply this framework to the entire organization and to a company in the knowledge‐based learning economy. Two sets of issues are of general concern to the company: internal issues surrounding the company's reward and recognition policies and practices and the provision of accounting and control information in a business‐relevant way to all levels of staff; and external issues concerning the extent to which the company and its members actively learn from other companies and effectively capture, disseminate and use information accessed by staff in boundary‐spanning roles. The paper concludes with some illustrations of changes being introduced by the company as a result of the feedback on and discussion of these issues.     

Maintaining New Procedures Using Feedback to Staff,a Hierarchical Reporting System,and a Multidisciplinary Management Group

Two studies are reported. In the f i s t it was shown that the introduction of activity period procedures by ward staff in a mental handicap hospital resulted in a marked increase in the level of residents' engaged behavior (mean 6.5% to mean 49.5%). with corresponding reductions in the incidence of neutral and inappropriate behavior. However, resident improvement alone did not result in the maintenance of these procedures during a 6 month follow-up period. The second study involved all levels of staff in the introduction of maintenance procedures, including private feedback to individuals, public display of resident engagement data, a reporting system using the existing hospital hierarchy, and a multidisciplinary management group. The introduction of this system in parallel with the reintroduction of the activity period procedures resulted in (a) further improvement in resident behavior (mean engagement levels increased from 19.1% to 6.16% and (b) consistency by the staff in following specified procedures. These high levels of resident engagement (mean 62%), and consistent staff practices were still maintained 30 weeks after the study ended.     

Qualitätsmanagement und Qualitätssicherung im Coaching

Quality management and quality assurance in coaching Presently, there is an apparent discrepancy between the demand for and the lack of quality discussion in coaching. In both the professional continuing education or staff development respectively and in psychotherapy these quality discussions have been led for a long time. These quality discussions are investigated according to a benchmarking. This article aims at transferring applicable knowledge from these working fields to coaching. Additionally it is focused on minimal standards in coaching which are already recognizable. Finally, conclusions are drawn with regard to urgent objectives around quality management in coaching which have to be achieved in future.     

An evaluation of the effects of a National Health Service Trust merger on the learning and development of staff

Although mergers are increasingly common amongst National Health Trusts in the UK there is limited research on how National Health Service (NHS) mergers influence the learning and development of staff. This paper bridges the gap in the literature, through a case-study of a recent NHS Trust merger. It gives an account of the delivery of human resource development (HRD) post merger as seen through the eyes of staff from across the merged organization. The data were obtained from 21 unstructured interviews, nine group discussions, two focus group discussions and a form of micro-ethnography. In addition, quantitative data were used for triangulation purposes. Findings show that power differentials, cultural clashes and unequal access to training and development amongst staff have resulted in hostility towards the new organization. However, the strong management structures for professional members of staff have facilitated knowledge exchange across boundaries in the merged organization. The paper concludes by suggesting that without senior managers dealing with cultural issues and inequitable development opportunities, a number of unintended consequences of the merger are likely to occur.     

Something Old,Something New?: Competing Logics and the Hybrid Nature of New Corporate Professions

The professionalization of certain management occupations, such as project management and human resource management, has been neglected in recent debates on professions, which instead focus upon the deregulation of collegial professions or the failure or unwillingness of new expert occupations to professionalize. Project management represents one of a handful of ‘management professions’ which confound this interpretation, explicitly pursuing a ‘corporate professionalization’ project with some degree of success. This paper focuses on the strategic activities of the principal British professional association in this field, the Association for Project Management (APM), as it negotiates a path between exploiting established sources of legitimacy and exploring a novel conception of professionalism. In the process, the association manipulates collegial and corporate logics of professionalism, in terms of its relationships with key stakeholders, its global orientation, its knowledge base and strategies of occupational closure. Drawing on interviews with APM officials and broader documentary analysis, we analyse the conditions which have produced this hybrid model of professionalism, highlighting the pragmatic management of tensions through the combination of distinct, even contradictory, professionalization logics.     

Hospital medical directors, quality of care, and financial returns

You are a physician executive working very hard within a hospital on all sorts of medical staff issues and quality of care. You answer to the board. The latter, through its administrators, may still have difficulty documenting the precise value of a full-time physician executive. Your hospital is losing money or not making enough profit for capital expenditures and salary raises. It is considering or will have to consider staff cuts. What can you do that will influence the bottom line, produce a quality image, and quantify your value?     

Physician executives: where they are and what they do

As hospital operations become increasingly complex, so does the institution's management and organizational structure. Physician executives with titles of medical director, vice president for medical affairs, medical administrator, chief of staff, medical staff president, etc., are playing more important roles than ever before. This article will briefly review some recent literature describing physician executive profiles. The results from a survey of ten university teaching hospitals are also presented as supplementary information regarding current staffing models. Finally, several physician executive staffing-related issues will be discussed in light of the literature and the survey results.     

Formatting and presenting quality data to medical staffs and hospital boards

A host of historical and practical precedents have made hospitals responsible for the quality of care rendered within their facilities. The medical staff and the board of trustees share in this responsibility. Increasing demands for demonstrative evidence of the quality of care in an institution have made the process data-based. There is no substitute for specific data on the performance of both the hospital and its providers in the delivery of care. The trick, however, is in presenting this information to the medical staff and the board in a fashion that will be understandable and that will still maintain confidentiality of provider and patient. The authors offer a presentation system that has met with success in their community hospital.     

A successful physician referral service.

Developing a successful hospital-based physician referral service can create a win-win-win venture involving the hospital, its medical staff, and the community at large. As a marketing tool for the hospital, it effectively targets two of the hospital's most important markets: physicians and the consumers of health services, the general public.