Excess capacity: markets regulation, and values.
OBJECTIVE: To examine the conceptual bases for the conflicting views of excess capacity in healthcare markets and their application in the context of today's turbulent environment. STUDY SETTING: The policy and research literature of the past three decades. STUDY DESIGN: The theoretical perspectives of alternative economic schools of thought are used to support different policy positions with regard to excess capacity. Changes in these policy positions over time are linked to changes in the economic and political environment of the period. The social values implied by this history are articulated. DATA COLLECTION: Standard library search procedures are used to identify relevant literature. PRINCIPAL FINDINGS: Alternative policy views of excess capacity in healthcare markets rely on differing theoretical foundations. Changes in the context in which policy decisions are made over time affect the dominant theoretical framework and, therefore, the dominant policy view of excess capacity. CONCLUSIONS: In the 1990s, multiple perspectives of optimal capacity still exist. However, our evolving history suggests a set of persistent values that should guide future policy in this area. (+info)
Theoretical framework for implementing a managed care curriculum for continuing medical education--Part I.
Healthcare reform has created a new working environment for practicing physicians, as economic issues have become inseparably intertwined with clinical practice. Although physicians have recognized this change, and some are returning to school for formal education in business and healthcare administration, formal education may not be practical or desirable for the majority of practicing physicians. Other curriculum models to meet the needs of these professionals should be considered, particularly given the growing interest in continuing education for physicians in the areas of managed care and related aspects of practice management. Currently, no theory-based models for implementing a managed care curriculum specifically for working physicians have been developed. This paper will integrate diffusion theory, instructional systems design theory, and learning theory as they apply to the implementation of a managed care curriculum for continuing medical education. Through integration of theory with practical application, a CME curriculum for practicing physicians can be both innovative as well as effective. This integration offers the benefit of educational programs within the context of realistic situations that physicians can apply to their own work settings. (+info)
Application of the problem-based learning model for continuing professional education: a continuing medical education program on managed care issues--Part II.
Physicians must incorporate concepts of practice management and knowledge of managed care into their practices. Managed care presents an immediate and challenging opportunity to providers of continuing medical education to offer effective educational programs for physicians on managed care issues. In this exploratory research, the problem-based learning model was used to develop a continuing medical education program that would offer an interactive and effective method for teaching physicians about managed care. Problem-based learning is a departure from the traditional lecture format of continuing medical education programs because it is designed for small groups of self-directed learners who are guided by a faculty facilitator. Although only a small number of participants participated in this program, the findings offer important considerations for providers of continuing medical education. For example, participants reported increased confidence in their knowledge about managed care issues. Participants also clearly indicated a preference for the small group, interactive format of the problem-based learning model. (+info)
An approach to an index of hospital performance.
Two indexes are described, based on measures of administrative effectiveness and patient care effectiveness. The measures used were selected and ranked by a Delphi panel from a list of 30 measures drawn from the literature. Weights were assigned by the panel to 19 selected measures. The resulting indexes did well in a test on data collected from 32 Texas hospitals. (+info)
The importance of a picture archiving and communications system (PACS) manager for large-scale PACS installations.
Installing a picture archiving and communication system (PACS) is a massive undertaking for any radiology department. Facilities making a successful transition to digital systems are finding that a PACS manager helps guide the way and offers a heightened return on the investment. The PACS manager fills a pivotal role in a multiyear, phased PACS installation. PACS managers navigate a facility through the complex sea of issues surrounding a PACS installation by coordinating the efforts of the vendor, radiology staff, hospital administration, and the information technology group. They are involved in the process from the purchase decision through the design and implementation phases. They can help administrators justify a PACS, purchase and shape the request for proposal (RFP) process before a vendor is even chosen. Once a supplier has been selected, the PACS manager works closely with the vendor and facility staff to determine the best equipment configuration for his or her facility, and makes certain that all deadlines are met during the planning and installation phase. The PACS manager also ensures that the infrastructure and backbone of the facility are ready for installation of the equipment. PACS managers also help the radiology staff gain acceptance of the technology by serving as teachers, troubleshooters, and the primary point-of-contact for all PACS issues. This session will demonstrate the value of a PACS manager, as well as point out ways to determine the manager's responsibilities. By the end of the session, participants will be able to describe the role of a PACS manager as it relates to departmental operation and in partnership with equipment vendors, justify a full-time position for a PACS manager, and identify the qualifications of candidates for the position of PACS manager. (+info)
The process of converting to a near filmless operation at the University of Utah, Department of Radiology.
The Department of Radiology at the University of Utah Health Sciences Center has made the transition from a traditional film-based department to a near filmless operation. The University of Utah is a large teaching hospital and the transition from film in an educational facility will be discussed. This transition has had its difficulties and its success is dependent on the support of departmental leadership and hospital administration. We have had more than 100 years of experience with film, and current procedures were efficient given the limitations of the medium. While motivated by the traditional reasons for moving to a picture archival and communications system (PACS), such as film savings, unavailable films, and faster reports, we found the intangibles to be the larger issue, as well as a source for the largest benefits. This report will discuss the implementation process and the affect it had on all areas of the hospital, including its impact on hospital physicians, radiologists, file room personnel, and technologists. Procedure changes to the flow of patients, film, and electronic images will also be described. This process cannot be viewed as a one-time change, but must be viewed as a continuous process as areas of improvement are identified and new and improved technologies are developed. (+info)
New picture archiving and communications system plus new facility equals critical path planning challenge.
The architectural design and construction of a new imaging department is one of the most complex challenges in healthcare architecture. When a client also plans a simultaneous change in basic operating system technology from film-based to filmless imaging, the challenge for both hospital management and the facility/technology design team is even more complicated. A purposeful planning process plus a carefully composed team of internal and external experts are the two essentials for success in executing this difficult conversion of both facility and technology. (+info)
Reporting comparative results from hospital patient surveys.
Externally-reported assessments of hospital quality are in increasing demand, as consumers, purchasers, providers, and public policy makers express growing interest in public disclosure of performance information. This article presents an analysis of a groundbreaking program in Massachusetts to measure and disseminate comparative quality information about patients' hospital experiences. The article emphasizes the reporting structure that was developed to address the project's dual goals of improving the quality of care delivered statewide while also advancing public accountability. Numerous trade-offs were encountered in developing reports that would satisfy a range of purchaser and provider constituencies. The final result was a reporting framework that emphasized preserving detail to ensure visibility for each participating hospital's strengths as well as its priority improvement areas. By avoiding oversimplification of the results, the measurement project helped to support a broad range of successful improvement activity statewide. (+info)