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A conceptual model of emergency department crowding

ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 173-180页

作者： Asplin, BR Magid, DJ Rhodes, KV Solberg, LI Lurie, N Camargo, CA Reg Hosp Dept Emergency Med St Paul MN 55101 USA HealthPartners Res Fdn St Paul MN 55101 USA Univ Minnesota Sch Med Dept Emergency Med Minneapolis MN 55455 USA Univ Colorado Hlth Sci Ctr Div Emergency Med Denver CO USA Univ Colorado Hlth Sci Ctr Dept Prevent Med & Biometr Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Clin Res Unit Colorado Permanente Med Grp Denver CO 80262 USA Univ Chicago Hosp Sect Emergency Med Chicago IL 60637 USA HealthPartners Res Fdn Minneapolis MN USA RAND Corp Arlington VA USA Harvard Univ Sch Med Channing Lab Dept Med Boston MA 02115 USA Massachusetts Gen Hosp Dept Emergency Med Boston MA 02114 USA

Emergency department (ED) crowding has become a major barrier to receiving timely emergency care in the United States. Despite widespread recognition of the problem, the research and policy agendas needed to understand and address ED crowding are just beginning to unfold. We present a conceptual model of ED crowding to help researchers, administrators, and policymakers understand its causes and develop potential solutions. The conceptual model partitions ED crowding into 3 interdependent components: input, throughput, and output. These components exist within an acute care system that is characterized by the delivery of unscheduled care. The goal of the conceptual model is to provide a practical framework on which an organized research, policy, and operations management agenda can be based to alleviate ED crowding.

关键词：急性病/治疗病床利用率/统计学和数值数据拥挤效率组织急诊室医院/组织和管理健康计划/组织和管理卫生政策卫生服务易得程度/组织和管理卫生服务研究住院时间/统计学和数值数据模型组织管理需求估价/组织和管理运筹学结果与过程评价(卫生保健)/组织和管理病人入院/统计学和数值数据病人出院/统计学和数值数据研究设计全面质量管理/组织和管理伤病员分拣/组织和管理美国

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Rhetoric or reality? The participation of disabled people in NGO planning

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HEALTH POLICY AND PLANNING 2000年第2期15卷 177-185页

作者： Flower, J Wirz, S UCL Inst Child Hlth Ctr Int Child Hlth London WC1N 1EH England

User involvement in planning is now well established in the fields of both health and development. This study looks at one particular client group, namely disabled people, and addresses the question: How do selected European-based international non-governmental organizations (INGOs) facilitate the participation of disabled people in their planning process? The study was exploratory in nature, using both quantitative and qualitative methods to answer the research question. Data were collected using a self-administered questionnaire with 18 INGOs, which was supported by five semi-structured interviews and 20 'e-mail dialogues' with key informants. The findings indicate that the INGOs involve disabled people's organizations (DPOs) in their planning of services and projects in a variety of ways. Most commonly this is through sharing information with them, bur consulting them, including them in decision-making or supporting action initiated by them are other less frequent methods of involvement. INGOs with a specific disability focus involve disabled people in the ways described above more frequently than other INGOs. Although most INGOs regularly provide information and consult DPOs, if there is no assurance that ideas raised will be implemented, then there is no guarantee of DPOs' participation in the planning process of these INGOs. The focus of an INGO and the nature of its projects affect how disabled people are involved in planning, whereas the size of an INGO has little effect. INGOs thus far have failed to match their expressed intentions about participation, but as they help to strengthen DPOs, encourage their formation and move to make disability an issue that cuts across sectoral boundaries, INGOs are changing. There is still a lot of rhetoric about participation, but the participation of disabled people in the planning process of INGOs is a growing reality.

关键词：用户参与/统计学和数值数据用户参与/发展趋势决策组织残疾人/统计学和数值数据欧洲法国大不列颠健康计划/组织和管理国际机构/组织和管理私营部门/组织和管理问卷调查人类

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Stakeholder analysis: a review

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HEALTH POLICY AND PLANNING 2000年第3期15卷 239-246页

作者： Brugha, R Varvasovszky, Z Univ London London Sch Hyg & Trop Med London WC1E 7HT England Natl Hlth Insurance Fund Budapest Hungary

The growing popularity of stakeholder analysis reflects an increasing recognition of how the characteristics of stakeholders - individuals, groups and organizations - influence decision-making processes. This paper reviews the origins and uses of stakeholder analysis, as described in the policy, health care management and development literature. Its roots are in the political and policy sciences, and in management theory where it has evolved into a systematic tool with clearly defined steps and applications for scanning the current and future organizational environment. Stakeholder analysis can be used to generate knowledge about the relevant actors so as to understand their behaviour, intentions, interrelations, agendas, interests, and the influence or resources they have brought - or could bring - to bear on decision-making processes. This information can then be used to develop strategies for managing these stakeholders, to facilitate the implementation of specific decisions or organizational objectives, or to understand the policy context and assess the feasibility of future policy directions. Policy development is a complex process which frequently takes place in an unstable and rapidly changing context, subject to unpredictable internal and external factors. As a cross-sectional view of an evolving picture, the utility of stakeholder analysis for predicting and managing the future is time-limited and it should be complemented by other policy analysis approaches.

关键词：决策组织卫生保健部门/组织和管理健康计划/组织和管理投资组织目标组织方针政策制订系统分析美国人类

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A stakeholder analysis

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HEALTH POLICY AND PLANNING 2000年第3期15卷 338-345页

作者： Varvasovszky, Z Brugha, R Natl Hlth Insurance Fund H-1137 Budapest Hungary Univ London London Sch Hyg & Trop Med London WC1E 7HT England

This paper provides guidance on how to do a stakeholder analysis, whether the aim is to conduct a policy analysis, predict policy development, implement a specific policy or project, or obtain an organizational advantage in one's dealings with other stakeholders. Using lessons learned from an analysis of alcohol policy development in Hungary, it outlines issues to be considered before undertaking the stakeholder analysis concerning the purpose and time dimensions of interest, the time-frame and the context in which the analysis will be conducted. It outlines advantages and disadvantages of an individual or team approach, and of the use of insiders and outsiders for the analysis. It describes how to identify and approach stakeholders and considers the use of qualitative or quantitative data collection methods for estimating stakeholder positions, levels of interest and influence around an issue. A key message is that the process of data collection and analysis needs to be iterative;the analyst needs to revise and deepen earlier levels of the analysis, as new data are obtained. Different examples of ways of analyzing, presenting and illustrating the information are provided. Stakeholder analysis is a useful tool for managing stakeholders and identifying opportunities to mobilize their support for a particular goal. However, various biases and uncertainties necessitate a cautious approach in using it and applying its results.

关键词：决策组织卫生保健部门/组织和管理健康计划/组织和管理机构间关系采访(主题) 投资规划技术政策制订公共卫生管理系统分析人类

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Statewide substance abuse prevention planning

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EVALUATION REVIEW 1996年第5期20卷 596-618页

作者： Breer, P McAuliffe, WE Levine, EB HARVARD UNIV CAMBRIDGE HOSP SCH MED DEPT PSYCHIAT CAMBRIDGE MA USA UNIV MARYLAND COLLEGE PK MD 20742 USA

The State of Rhode Island contracted with the authors to prepare a statewide, comprehensive substance abuse prevention plan. The literature review revealed a lack of research on statewide planning for prevention services. To obtain data for Rhode Island's plan, the authors conducted a family of studies including synthetic estimation, key informant interviews, a telephone survey of agency directors, program budget analysis, construction of a statistical index for estimating the optimal geographic allocation of prevention dollars, and a review of General Laws regarding tobacco, alcohol, and other drugs. Their recommendations include the increased funding and coordination of prevention services, allocating services according to need rather than population size, greater use of social policy as a prevention tool, and a shift in primary prevention programming from senior high to lower grades and in program emphasis from information-education to psychosocial programs.

关键词：药品和麻醉品检定/立法和法学健康计划/经济学健康计划/组织和管理卫生服务需求政府政策罗得岛物质相关性障碍/预防和控制人类

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Leadership and productivity in planning organizations: A case study

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Administration in Social Work 1978年第1期2卷 85-94页

作者： Whitcomb, Robert G. Williams, Eleanor Golar College of Social Work University of South Carolina Columbia SC 29208 United States

This paper presents the findings of a case study dealing mainly with the effects of two divergent leadership styles on the productivity of a planning organization. Changes in various kinds of participation in the agency's activities—an important side effect—are also linked to the two leadership patterns. The agency studied, a private health and welfare council in a medium-sited American city, varied considerably in its output of planning activities and decision making depending on whether it had a participative or a directive leader. The results indicated that there was a trade-off between such highly revered social values as leadership and the extent of participation by staff, board members, and local agency administrators. Implications focus on ways to achieve diversity in communication style among managers and the role of productivity measures in determining the overall effectiveness of planning agencies. © 1978 by The Haworth Press, Inc. All rights reserved.

关键词：行政管理人员效率健康计划/组织和管理领导美国志愿卫生机构/组织和管理人类

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Thinking about a mobile health unit to deliver services? Things to consider before buying.

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The Australian journal of rural health 2000年第1期8卷 6-16页

作者： Moulavi, D. Bushy, A. Peterson, J. Stullenbarger, E. University of Central Florida School of Nursing Orlando Regional Medical Center Orlando United States

Purchasing a mobile unit to deliver health-care services can be an expensive undertaking for anyone interested in pursuing this option. Yet, little information is found in the literature on planning or designing such vehicles. A set of guidelines could help administrators to make better decisions regarding this approach for delivering healthcare. This article focuses on mobile health units (MHU). It provides a synthesis of the literature in addition to information from written and oral correspondence with the chief executive officers (CEO) of firms that manufacture MHU. On-site visits to agencies using an MHU were made by one of the authors (DM) to glean their perspective. The combined sources led to the development of guidelines and checklists that can assist administrators in planning the function, design and operation of an MHU to deliver health-care services to remote rural sites.

关键词：费用效益分析决策组织健康计划/组织和管理巡回卫生队/组织和管理需求估价/组织和管理诊所评价和购买/组织和管理乡村卫生服务/组织和管理人类

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Health policy in finland

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International Journal of Technology Assessment in Health Care 1988年第3期4卷 375-384页

作者： Guv, Bäckman Åbo-Akademi United Kingdom

This article surveys attempts by the Finnish government to plan and budget health care since the Primary Health Care Act of 1972. A national board of health allocates approved resources to local authorities who develop plans for preventative and primary health care and hospital services. The acquisition of expensive technologies are debated at the national level. The author presents studies which suggest that there is a considerable need for expansion of both diagnostic and therapeutic technologies in Finland. These adjustments will be necessary to meet the needs of an economically, socially, and demographically changing country. © 1988, Cambridge University Press. All rights reserved.

关键词：数据收集人口统计学芬兰卫生经费支出健康计划/组织和管理卫生政策医院初级卫生保健/组织和管理工艺学高成本

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Integrated workforce planning. The acid test for the education commissioning consortia?

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Journal of management in medicine 1999年第1期13.0卷 33-40页

作者： Edmonstone, J. MTDS Harrogate North Yorkshire United Kingdom

The education commissioning system established in the NHS in England in the mid-1990s is facing a series of reviews. A major challenge which it faces is how integrated workforce planning is addressed. Newly-emerging approaches to planning are reviewed and the nature of "integration" examined. Sensitive management of the change process will be needed to "learn our way into the future".

关键词：决策组织教育牙科研究生/组织和管理教育医学研究生/组织和管理大不列颠卫生职业/教育健康计划/组织和管理病人医疗小组规划技术专业能力人员开发公费医疗/组织和管理培训资助

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The evaluation of health development: the next methodological frontier?

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999年第2期23卷 117-118页

作者： Legge, D La Trobe Univ Sch Publ Hlth Bundoora Vic Australia

The article evaluates health development. The term 'health development' is used as a generic hold, all to encompass the range of principles, strategies and styles of practice which have been developed in various sectors of public health practice to address the social influences on population health. Health development strategies are commonly directed at outcomes which are projected some considerable distance into the future. This is particularly so where the conditions for poor health are embedded in history and social relations, as in the case of Aboriginal health, or in the distribution of power and income, as in the case of socio-economic inequalities. Health development strategies are insecure in the present health policy and health care environment, partly because of the expectation among policy makers that prevention, as well as diagnosis and treatment, will achieve measurable outcomes and will be evidence-based. Advocates for health development strategies are at some disadvantage in this environment because of the difficulties in measuring outcomes and demonstrating effectiveness.

关键词：健康计划/组织和管理健康状况规划制订方案评价社会环境维多利亚人类

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