Is contracting a form of privatization?
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Contracting is often seen as a form of privatization, with contracts functioning as the tool that makes privatization possible. But contracting is also viewed by some as a means for the private sector to expand in a covert way its presence within the health sector. This article discusses the wider meaning of the term privatization in the health sector and the ways in which it is achieved. Privatization is seen here not simply as an action that leads to a new situation but also as one that leads to a change in behaviour. It is proposed that privatization may be assessed by looking at the ownership, management, and mission or objectives of the entity being privatized. Discussed also is the use of contracting by the state as a tool for state interventionism that is not based on authoritarian regulation. (+info)
System of indexes and indicators for the quality evaluation of HACCP plans based on the results of the official controls conducted by the Servizio di Igiene degli Alimenti della Nutrizione (Food and Nutrition Health Service) of the Local Health Authority of Foggia, Italy.
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Within the realm of evaluating self-monitoring plans, developed based on the Hazard Analysis and Critical Control Points (HACCP) method and adopted by food companies, little research has been done concerning the quality of the plans. The Servizio di Igiene degli Alimenti e della Nutrizione (Food and Nutrition Health Service) of the Local Health Authority of Foggia, Italy, has conducted research with the aim to adopt a system of indexes and indicators for the qualitative evaluation of HACCP plans. The critical areas considered were the following: simplicity, specificity, feasibility and adherence. During the period from January 2004 to June 2005, the evaluation grid was used in examining 250 HACCP self-monitoring plans of food companies. For the analysis of the determining factor four groups were considered, with reference to HACCP self-monitoring plans designed: group 1 - with the aid of a qualified team; group 2 - with the aid of an unqualified team; group 3 - with the aid of an unqualified expert; group 4 - without the aid of an expert. The mean values of the measures elaborated decrease towards insufficiency moving from group 1 to group 4. In particular, collaboration by teams of unqualified experts brought about drafting unacceptable HACCP plans on the levels of specificity and adherence, with respect to the HACCP method. The method proposed of the analysis of the indexes and indicators beginning with an evaluation sheet can also help the individual company to better adjust contribution by internal or external professionals to the company. (+info)
Mapping the literature of health care management.
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OBJECTIVES: The research provides an overview of the health care management literature and the indexing coverage of core journal literature. METHOD: Citations from five source journals for the years 2002 through 2004 were studied using the protocols of the Mapping the Literature of Allied Health Project and Mapping the Literature of Nursing Project. The productivity of cited journals was analyzed by applying Bradford's Law of Scattering. RESULTS: Journals were the most frequently cited format, followed by books. Only 3.2% of the cited journal titles from all 5 source journals generated two-thirds of the cited titles. When only the health care management practitioner-oriented source journals were considered, two-thirds of the output of cited journal titles came from 10.8% of the titles. Science Citation Index and PubMed provided the best overall coverage of the titles cited by all 5 source journals, while the cited titles from the 2 practitioner-oriented journals were covered most completely by Social Sciences Citation Index and Business Source Complete. CONCLUSIONS: Health care management is a multidisciplinary field. Librarians must consider the needs of their users and assist them by providing the necessary materials and combination of indexes to access this field adequately. (+info)
Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models.
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OBJECTIVE: To compare risk prediction models for death in hospital based on an administrative database with published results based on data derived from three national clinical databases: the national cardiac surgical database, the national vascular database and the colorectal cancer study. DESIGN: Analysis of inpatient hospital episode statistics. Predictive model developed using multiple logistic regression. SETTING: NHS hospital trusts in England. PATIENTS: All patients admitted to an NHS hospital within England for isolated coronary artery bypass graft (CABG), repair of abdominal aortic aneurysm, and colorectal excision for cancer from 1996-7 to 2003-4. MAIN OUTCOME MEASURES: Deaths in hospital. Performance of models assessed with receiver operating characteristic (ROC) curve scores measuring discrimination (<0.7=poor, 0.7-0.8=reasonable, >0.8=good) and both Hosmer-Lemeshow statistics and standardised residuals measuring goodness of fit. RESULTS: During the study period 152 523 cases of isolated CABG with 3247 deaths in hospital (2.1%), 12 781 repairs of ruptured abdominal aortic aneurysm (5987 deaths, 46.8%), 31 705 repairs of unruptured abdominal aortic aneurysm (3246 deaths, 10.2%), and 144,370 colorectal resections for cancer (10,424 deaths, 7.2%) were recorded. The power of the complex predictive model was comparable with that of models based on clinical datasets with ROC curve scores of 0.77 (v 0.78 from clinical database) for isolated CABG, 0.66 (v 0.65) and 0.74 (v 0.70) for repairs of ruptured and unruptured abdominal aortic aneurysm, respectively, and 0.80 (v 0.78) for colorectal excision for cancer. Calibration plots generally showed good agreement between observed and predicted mortality. CONCLUSIONS: Routinely collected administrative data can be used to predict risk with similar discrimination to clinical databases. The creative use of such data to adjust for case mix would be useful for monitoring healthcare performance and could usefully complement clinical databases. Further work on other procedures and diagnoses could result in a suite of models for performance adjusted for case mix for a range of specialties and procedures. (+info)
Using a Malcolm Baldrige framework to understand high-performing clinical microsystems.
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BACKGROUND, OBJECTIVES AND METHOD: The Malcolm Baldrige National Quality Award (MBNQA) provides a set of criteria for organisational quality assessment and improvement that has been used by thousands of business, healthcare and educational organisations for more than a decade. The criteria can be used as a tool for self-evaluation, and are widely recognised as a robust framework for design and evaluation of healthcare systems. The clinical microsystem, as an organisational construct, is a systems approach for providing clinical care based on theories from organisational development, leadership and improvement. This study compared the MBNQA criteria for healthcare and the success factors of high-performing clinical microsystems to (1) determine whether microsystem success characteristics cover the same range of issues addressed by the Baldrige criteria and (2) examine whether this comparison might better inform our understanding of either framework. RESULTS AND CONCLUSIONS: Both Baldrige criteria and microsystem success characteristics cover a wide range of areas crucial to high performance. Those particularly called out by this analysis are organisational leadership, work systems and service processes from a Baldrige standpoint, and leadership, performance results, process improvement, and information and information technology from the microsystem success characteristics view. Although in many cases the relationship between Baldrige criteria and microsystem success characteristics are obvious, in others the analysis points to ways in which the Baldrige criteria might be better understood and worked with by a microsystem through the design of work systems and a deep understanding of processes. Several tools are available for those who wish to engage in self-assessment based on MBNQA criteria and microsystem characteristics. (+info)
Adolescent pregnancy: a comparative study between mothers who use public and private health systems.
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This is a comparative and descriptive study of adolescent mothers who were attended in three maternities of the public health system and three private maternities in a city in Sao Paulo, Brazil, between 2000 and 2002. This study aimed to compare the profile of mothers attended in both systems. The database of Ribeirao Preto was used and 5,286 adolescent mothers between 10 and 19 years old were selected according to type of delivery, level of instruction, number of prenatal consultations and parity. We found that the users of the public health system had less prenatal consultations, lower level of education, higher parity and the vaginal delivery was most frequent. The users of the private health system, on the contrary, had more prenatal consultations, higher level of instruction, and primiparity and cesarean sections were more frequent. (+info)
The maintenance care of potential organ donors: ethnographic study on the experience of a nursing team.
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This ethnographic study aimed to understand a nursing team's experience on the maintenance of potential organ donors. Data were collected through ethnographic interview, participative observation and documental analysis and analyzed in thematic, cultural domain and taxonomical terms. The research enabled us to identify the meaning of brain death, revealing the interrelation between the categories (units, nursing team and patient), which constituted this study main theme: "it is not a person". The transplant meaning held by the nursing team is marked by disbelief due to some previous experiences in the Intensive Therapy Unit. Thus, beliefs and values of this subculture interfere or determine a distancing from the patient with a consequent loss in the maintenance of the potential donor and quality of the organs donated. (+info)
Social representations of the Brazilian national health care system in the city of Rio de Janeiro, Brazil, according to the structural approach.
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The Brazilian National Health Care System The Single Health System (SHS) [SUS-Sistema Unico de Saude] faces difficulties for its effective implementation. This paper aims to characterize the contents and the social representation structure of the Brazilian health care system among health care professionals in the city of Rio de Janeiro. The concept of social memory and the theory of social representation were adopted as frameworks. Five health care institutions were included in this research, with 100 professionals altogether. The free-association technique was used to collect data and the EVOC 2003 software was used analyzed for data analysis. The results signal to a central nucleus, characterized by negative attitudes regarding the SUS. In the contrast area, there is a negative attitude towards the effectiveness of the system and a positive attitude towards the care provided to service users, also showing other principles. At its periphery, the implementation of new opinions about the representation could be observed. It is concluded that the professionals present social representations that recognize the SUS as a new system, eliciting negative attitudes among the professionals, and that is in a process of formation or progressive transformation, raising judgments about the pertinence of the system's principles. (+info)