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Physician leadership is essential to the survival of teaching hospitals

AMERICAN JOURNAL OF SURGERY 2000年第6期179卷 462-468页

作者： Schwartz, RW Pogge, C Univ Kentucky Albert B Chandler Med Ctr Dept Surg Coll Med Lexington KY 40536 USA

BACKGROUND: Academic medical centers (AMCs) face severe financial constraints because they must now compete directly with private providers that focus exclusively on cost-effective healthcare delivery. Educational and research capacities developed at AMCs have been supported by government and third party payers, but government support is diminishing. Physicians are ill-equipped to respond to market pressures. DATA SOURCES: Analyses of cultural change and restructuring in corporate giants such as Greyhound, IBM and FedEx are relevant to teaching hospitals. To succeed, organizations must flatten hierarchy, empower staff, train leaders, and mobilize intellectual capital. Effective leadership is essential. CONCLUSION: Physicians must educate themselves on forces impacting the AMC, understand changes needed in the structure and processes of AMC governance and acquire competencies for leadership and management if AMCs are to survive and thrive. Surgeons should acquire competencies that will enable them to become leaders in the process of AMC transformation. (C) 2000 by Excerpta Medica, Inc.

关键词：医学科学研究中心/组织和管理预测卫生保健部门/组织和管理卫生保健部门/标准卫生保健部门/发展趋势医院教学/组织和管理领导医师的作用专业能力美国人类

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Reengineering and infection control programs: Commentary and a case study

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第1期28卷 44-50页

作者： Jackson, M Massanari, RM Univ Calif San Diego Med Ctr Dept Nursing Res & Educ San Diego CA 92103 USA

Transformation of the health care system has been an ongoing process for generations, but many changes in the past 2 decades have focused on reducing costs in concert with rapidly changing technologies and demands for high quality care. Many cost-containment efforts in the 1990s are characterized by attempts to apply the business model for "reengineering the corporation" to health care systems. This commentary reviews principles of reengineering and how strategies to reduce costs through market forces, competition, and downsizing can result in substantial problems for bureaucratic organizations unaccustomed to rapid change and innovation. A case study drawn from experiences of a large metropolitan academic health care system is presented, with specific focus on lessons that will be helpful to infection control professionals (ICPs) confronted with similar situations.

关键词：医学科学研究中心/组织和管理费用控制经济竞争卫生保健部门/组织和管理医院改组/组织和管理感染控制/组织和管理美国中西部组织状况研究组织改革结果与过程评价(卫生保健)/组织和管理人员减少/组织和管理政治人类

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Rapid process redesign in a university-based emergency department: Decreasing waiting time intervals and improving patient satisfaction

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ANNALS OF EMERGENCY MEDICINE 2002年第2期39卷 168-177页

作者： Spaite, DW Bartholomeaux, F Guisto, J Lindberg, E Hull, B Eyherabide, A Lanyon, S Criss, EA Valenzuela, TD Conroy, C Univ Arizona Coll Med Arizona Emergency Med Res Ctr Dept Emergency Med Tucson AZ USA Univ Med Ctr Tucson AZ USA

Academic emergency departments are traditionally associated with inefficiency and long waits. The academic medical model presents unique barriers to system changes. Several non-university-based EDs have undertaken process redesign, with significant decreases in patient waiting time intervals. This is the presentation of a rapid process redesign in a university-based ED to reduce waiting time intervals. We present the application of a process-improvement team approach to evaluate and redesign patient flow, As a result of this effort, the median waiting room time interval (triage to patient room) decreased from 31 minutes in January 1998 to 4 minutes-in July 1998, ED throughput times also decreased, from 4 hours, 21 minutes in January 1998 to 2 hours, 55 minutes in July 1998, Urgent care waiting room time intervals decreased from 52 minutes to 7 minutes and throughput times from 2 hours, 9 minutes to 1 hour, 10 minutes. Patient satisfaction evaluations by an independent institute demonstrated dramatic improvement and establishment of a new benchmark for academic EDs. Process redesign is possible in a busy, complex, tertiary-care ED, with decreases in waiting time intervals and improvement in patient satisfaction. Major sustained support from top-level hospital administrators and physician leadership are fundamental prerequisites. With these in place, a process improvement team approach for evaluating and redesigning the patient care system can be successful.

关键词：医学科学研究中心/组织和管理急诊室医院/组织和管理医院设计和建设病人满意度时间因素人类

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Academic practice groups: Strategy for survival

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SURGERY 2000年第4期128卷 505-510页

作者： Rodriguez, JL Jacobs, DM Zera, RT Van Camp, JM Muehlstedt, SG West, MA Bubrick, MP Univ Minnesota Sch Med Hennepin Cty Med Ctr Dept Surg Minneapolis MN 55455 USA

Background. The mission of public academic health centers (puAHC) and their affiliated practice groups (APG) focuses on teaching, research, and the clinical care of at-risk populations. Resources to accomplish this mission, however, are becoming scarce. For puAHC to survive and remain competitive, innovative strategies will need to be developed by the APG. We hypothesized that the integration of a surgical academic practice of the APG with a nonacademic integrated health care delivery system (NAIDS) in a managed care environment would benefit all involved. Methods. A surgical academic practice was integrated with a NAIDS in a 95% managed care market. Faculty alone provided care the first year and third-year residents were added the following year. To assess outcome, we collected benefit and cost data for the 1-year period before integration and compared them with the two, 1-year periods after integration. Results. In the second year of integration 1-revenues from the NAIDS referrals to the puAHC and APG increased 89% and 150%, respectively. The NAIDS' general surgical and endoscopy caseload increased by 25%. Additionally, there was a 92% reduction in operating room technician cost with no increase in operating time per case. Finally, the third-year resident experienced a caseload increase of 163%. Conclusions. In an environment where resources are diminishing and managed care consists of many large NAIDS that drive referrals and revenue, the integration of a surgical academic practice with a NAIDS benefits all shareholders. Academic practice groups that develop strategies that leverage their competitive advantage will have the best chance of surviving in today's turbulent health care market.

关键词：医学科学研究中心/组织和管理卫生保健提供联合/组织和管理全体教工医学院校/组织和管理联合开业/组织和管理医院县/组织和管理实习医师和住院医师职务/组织和管理管理医疗规划/组织和管理卫生服务使用研究组织隶属关系结果评价(卫生保健) 外科学/组织和管理人类

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The incidence of cancellation and nonattendance at a dermatology clinic

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JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 1999年第5期40卷 714-718页

作者： Penneys, NS Glaser, DA St Louis Univ Ctr Sci Dept Dermatol St Louis MO 63104 USA

Background: Same-day cancellation of appointments and nonattendance by patients can disrupt management of certain aspects of medical delivery and lead to inefficient allocation of resources and lost revenue. The frequency of cancellation and nonattendance at dermatology clinics has not been well documented. Objective: We measured same-day cancellation and nonattendance in a university dermatology clinic. Methods: We tabulated clinic attendees, same-day cancellations, and nonattendance for a 6-month period. We examined distribution by gender, type of payer, and clinic visit type (initial or follow-up). Results: Total same-day cancellation rate was 8.3%. Female patients canceled more frequently than male patients (9.2% vs 7.3%, P =.02). Cancellation rates were similar for initial and follow-up visits. The nonattendance rate was 17% with the highest rates found in state-supported categories (26%) and the lowest in commercial insurance programs (13%). Nonattendance rates did not vary significantly by gender or visit type. Conclusion: Same-day cancellation and clinic nonattendance is a significant factor in the efficient fiscally sound management of a busy dermatology clinic. The risk of nonattendance is assumed by physicians and seems to be correlated with payer type.

关键词：医学科学研究中心/经济学医学科学研究中心/组织和管理门诊医疗设施/经济学门诊医疗设施/组织和管理病人预约和时间安排皮肤病学财务管理随访研究卫生保健公平提供发病率保险健康 Medicaid Medicare 性别因素时间因素美国女(雌)性人类男(雄)性

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Deficiency or opportunity?

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ACADEMIC RADIOLOGY 2001年第8期8卷 693-695页

作者： Dunnick, NR Univ Michigan Med Ctr Dept Radiol Ann Arbor MI 48109 USA

In this issue of Academic Radiology, four successful academic radiologists address critical issues in academic medicine. The points they make are not unique to radiology, but they are pervasive throughout academic medical communities. Each article offers an opportunity for improvement as it points out a deficiency in our current system. Dr Davis describes the difficulty of using relative value units (RVUs) to measure physician productivity (1). Drs Collins and Smith argue that research into teaching is an important aspect of scholarship (2). Dr Gunderman points out that radiology has no system to develop its future leaders (3). Finally, Dr Pisano's treatise on time management is in response to the many demands—both professional and personal—on the academic radiologist's time (4). While few would argue with the points made in these articles, the solutions necessary to address them are not easily *** radiology departments prioritize their activities. The most pressing of these obligations is the clinical service they provide in care of their patients. Patient care is our ultimate goal, and radiology services are becoming increasingly important. Jonathan Sunshine estimates that change in the practice of medicine accounts for an increase in the use of radiology services of 2.5%–6% annually (5). This reflects referring physicians' perceptions of the value of radiology services. Cross-sectional imaging tests are used with increasing frequency as the time available for a careful history and physical examination is diminishing. Interventional techniques accomplish therapeutic intervention that once required surgery. We are now looking at huge potential increases in the number of imaging tests performed as screening tests threaten to expand beyond mammography into computed tomographic (CT) colonography, chest CT, and even “total body CT.” Radiology services support the patient care activities of our clinical colleagues and, for the most part, are good for patients

关键词：医学科学研究中心/组织和管理放射学/经济学放射学/教育放射学/方法相对价值表研究/发展趋势教学/标准

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Reproductive medicine and research: contract laboratories vs. the university-based researcher

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FERTILITY AND STERILITY 2000年第4期73卷 677-679页

作者： Blackwell, RE Univ Alabama Dept Obstet & Gynecol Reprod Biol & Endocrinol Birmingham AL 35233 USA

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A rural cancer outreach program lowers patient care costs and benefits both the rural hospitals and sponsoring academic medical center

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JOURNAL OF RURAL HEALTH 1999年第2期15卷 157-167页

作者： Desch, CE Grasso, MA McCue, MJ Buonaiuto, D Grasso, K Johantgen, MK Shaw, JE Smith, TJ Virginia Commonwealth Univ Med Coll Virginia Massey Canc Ctr Rural Canc Outreach Program Richmond VA 23298 USA Med Coll Virginia Hosp Richmond VA 23298 USA Virginia Commonwealth Univ Sch Hlth Adm Richmond VA 23298 USA Amer Soc Clin Oncol Hlth Serv Res Comm Chicago IL 60611 USA

The Rural Cancer Outreach Program (RCOP) between two rural hospitals and the Medical College of Virginia's Massey Cancer Center (MCC) was developed to bring state-of-the-art cancer care to medically underserved rural patients. The financial data were collected on 1,745 cancer patients treated at the participating centers, two rural community hospitals and the MCC. The main outcome measures were costs (estimated reimbursement from all sources), revenues, contribution margins and profit (or loss) of the program. The RCOP may have enhanced access to cancer care for rural patients at less cost to society. The net annual cost per patient fell from $10,233 to $3,862 associated with more use of outpatient services, more efficient use of resources, and the shift to a less expensive locus of care. The cost for each rural patient admitted to the Medical College of Virginia fell by more than 40 percent compared with only an 8 percent decrease for all other cancer patients. The rural hospitals experienced rapid growth of their programs to more than 200 new patients yearly, and the RCOP generated significant profits for them. MCC benefited from increased referrals from RCOP service areas by 330 percent for cancer patients during the same time period. While it did not generated enough revenue to cover costs of the program. The RCOP had a positive financial impact on the rural and academic medical center hospitals, provided state-of-the-art care near home for rural patients and was associated with lower overall cancer treatment costs.

关键词：医学科学研究中心/经济学医学科学研究中心/组织和管理社区和机构的关系/经济学费用效益分析卫生保健费用医院乡村/经济学医院乡村/组织和管理缺医地区肿瘤/治疗组织隶属关系/经济学方案评价转诊和会诊乡村卫生服务/经济学乡村卫生服务/组织和管理农村人口弗吉尼亚人类

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Meeting the information needs of students and professionals: The health informatics education center at the houston academy of medicine-texas medical center library

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Medical Reference Services Quarterly 1998年第4期17卷 85-90页

作者： Barclay, Donald A. Camille, Damon Houston Academy of Medicine-Texas Medical Center Library Houston TX United States

Click to increase image sizeClick to decrease image size

关键词：医学科学研究中心/组织和管理卫生人员信息中心/组织和管理信息服务/供应和分配图书馆医学/组织和管理软件学生医科得克萨斯

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THE ORGANIZATION AND MANAGEMENT OF MEDICAL-EDUCATION IN AUSTRALIA

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HEALTH POLICY AND EDUCATION 1981年第2期2卷 177-206页

作者： ROTEM, A CRAIG, P COX, KR EWAN, CE Centre for Medical Education Research and Development University of New South Wales Kensington New South Wales 2033 Australia

The review highlights the interdependence among the various subsystems involved in medical education and hence the need for coordination. Observations and perceptions derived from interviews and the review of the literature were reported to underline the existing difficulties and factors which impede the integration of efforts of the various subsystems. Problems of coordination seem to relate to the functioning of the existing mechanisms rather than to the absence of structural arrangements. Hence, it seems necessary to improve the skill of committees and other coordinating bodies in the processes of mutual adjustment and responsiveness to changing conditions.

关键词：医学科学研究中心/组织和管理澳大利亚教育医学实习医师和住院医师职务院校医学

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