Relations between physicians and nurses are sometimes strained. Physician-nurse conflict, tension, and stress have been thought to be contributing factors in job dissatisfaction and burnout for nurses.
Controversy arises about the reasons for physician-nurse conflict, possible solutions to this problem, and the proper relationship between physicians and nurses.
Conflict and tension do not characterize all physician-nurse relations. In many healthcare contexts physicians and nurses communicate and work together to serve their patients. Conflict can occur between workers in business and professional contexts outside of healthcare, of course. Workers may not get along because of personality differences of various sorts. Workers may perceive they are being treated unfairly relative to coworkers. The organization may create a situation of competition among workers. Sexual harassment can occur. Situations such as these may conflict and tension between coworkers or between supervisor and coworker.I believe that in this instance,management should be made aware of such problems and take steps to address and resolve them.
Some other physician- nurse relationships are causesd by interpersonal conflict. This occurs in many areas of business and personal relationships and sometimes it is due to the particular personalities of the parties involved. Some people are simply less friendly, more impatient, have greater expectations, etc. than others. This can occur in relations among physicians, among nurses, and between physicians and nurses.
Another issue is the power imbalance between physicians and nurses in modern healthcare in the United States is well known. This power imbalance occurs both outside and inside healthcare.
As an adminstrator,vone common recommendation is to improve communication between physicians and nurses. Poor communication can result in unmet expectations and resulting frustration and poor working relationships.
Another suggestion is that there be available an optimal method of conflict resolution. Nurses sometimes avoid conflict or are resigned to it, whereas some form of conflict resolution fostering collaboration and cooperation might help alleviate physician-nurse tensions and achieve better overall outcomes.
An important point to note is that conflict between physicians and nurses is likely to hurt the optimal functioning of the team and result in poorer patient care and lower quality healthcare, so as the administrator i would take whatever steps are necessary to ensure the organizational culture and management support create an environment in which such destructive conflict is minimized and nurses feel more empowered.
As the administrator, I believe in a hospital setting, the head physician executive (such as the medical director) and head nursing executive (such as the director of nursing) should build a relationship of collaboration and mutual respect that can act as a model for others. They should learn each other’s disciplines and contributions. They should also develop an organizational vision of how physicians and nurses should interact. This vision should include expectations of their own and other’s behavior – physicians stating their expectations for nurses and nurses stating their expectations for physicians. The vision and expectations should then be translated into standards of behavior and concrete policies to correct misbehavior (violations of the standards). Inappropriate behavior will not change unless it results in consequences for the perpetrator.
Furthermore, they should examine hospital systems and policies to ensure they are not interfering with the development of better relations; for example, if nurses have to police the physicians’ compliance with medical record policies, collaboration will be difficult. Also, opportunities for collaboration should be pursued – physicians providing continuing education to nurses, nurse serving on credentialing committees, etc. -- where they can develop respect and good working relations.
In conclusion, the problem of physician-nurse conflict needs to be addressed not just by individual clinicians but by a healthcare organization’s executive leaders. Hospital administrators and managers may prefer to avoid dealing with the problem. Rather than trying to sweep the problem under the rug, senior management should work to develop an organizational culture in which inappropriate attitudes and behavior of physicians toward nurses and vice versa are not tolerated.
Sunday, March 18, 2012
PLN 6: How to size up your Hospital?
After reading the article " how to size up your hospital," it gives you an insight on how to determine if a hospital is giving good quality based on certain criterias. For instance how consistently your local hospital gives heart-attack patients a kind of medication called beta-blockers, or what proportion of surgery patients get antibiotics an hour before surgery. These type of criterias gives off certain strengths and weaknesses within a hospital and shows us as consumers if we would like to indulge in becoming apart of that particular health care system or choose one that is better suited based on better quality.
After getting on the leap frog website, I compared two hospitals based on that specific criteria to see which each strength and weakness was of each, of course accoring with the information provided. The two hospitals were CJW Medical Center- Johnston - Willis Campus in rich mond VA, and Anne arundel Medical Center.
Now, after just looking over the different criterias from first glance, it shows that Anne arundel Medical Center fully meets the standards for all of the categories mentioned except for the heart bypass surgery, becasue it does not apply. It shows that this hospial has a lot of strengths to it.
Reviewing the information about CJW Medical Center Johnston- Willis Campus it seems that the ratings are a bit less. For instance in the prevent medication errors, it shows one bar which indicates that the have a willingness to report the errors, but most likely they do not report which shows a weakness in the companys category for preventing medication errors. Also another weakness that this hospital shows is that it does not takes the necessary steps to prevent harm in the hospital, which is represented by one single bar as well.
After changing into different categories,it shows that the stronger hospital still remains to be Anne arundel Medical Center. Another criteria was based off of patient outcomes. The outcomes I chose was Heart bypass surgery, and abdominal aortic aneurism repair. Based on these choices it shows the strengths of Anne Arundel was still high in quality care. In the avoid harm category, it showsit had great progress. In the hospital of CJW Medical center, it still shows this hospital has a lot of weakness in the areas of preventing medication errors, steps to avoid haarm. But the strength based off the categories provides did show that the bypass surgery itself quality and cost were very good.
1.http://www.leapfroggroup.org/cp?frmbmd=cp_listings&find_by=zip&zip=20020&radius=100&cols=oa
After getting on the leap frog website, I compared two hospitals based on that specific criteria to see which each strength and weakness was of each, of course accoring with the information provided. The two hospitals were CJW Medical Center- Johnston - Willis Campus in rich mond VA, and Anne arundel Medical Center.
Now, after just looking over the different criterias from first glance, it shows that Anne arundel Medical Center fully meets the standards for all of the categories mentioned except for the heart bypass surgery, becasue it does not apply. It shows that this hospial has a lot of strengths to it.
Reviewing the information about CJW Medical Center Johnston- Willis Campus it seems that the ratings are a bit less. For instance in the prevent medication errors, it shows one bar which indicates that the have a willingness to report the errors, but most likely they do not report which shows a weakness in the companys category for preventing medication errors. Also another weakness that this hospital shows is that it does not takes the necessary steps to prevent harm in the hospital, which is represented by one single bar as well.
After changing into different categories,it shows that the stronger hospital still remains to be Anne arundel Medical Center. Another criteria was based off of patient outcomes. The outcomes I chose was Heart bypass surgery, and abdominal aortic aneurism repair. Based on these choices it shows the strengths of Anne Arundel was still high in quality care. In the avoid harm category, it showsit had great progress. In the hospital of CJW Medical center, it still shows this hospital has a lot of weakness in the areas of preventing medication errors, steps to avoid haarm. But the strength based off the categories provides did show that the bypass surgery itself quality and cost were very good.
1.http://www.leapfroggroup.org/cp?frmbmd=cp_listings&find_by=zip&zip=20020&radius=100&cols=oa
PLN 5 : HOW CAN WE IMPROVE HEALTHCARE QUALITY?
I recently read an article which talked about the causes of quality problems. It stated how patients suffer harm because of three different types of quality problems. The first occurs when patients do not get beneficial health services. The second happens when patients undergo treatments or procedures from which they will not benefit. The third occurs when patients receive appropriate medical services, but those services are provided badly, exposing patients to added risk of preventable complications.
Extensive research has documented that all three forms of clinical quality problems—underuse, overuse, and misuse—are ubiquitous in American medicine and deserve urgent attention.Substantial underuse of effective interventions pervades the delivery of preventive care, acute care, and chronic care; it occurs across age groups, reimbursement schemes, geographic regions, and sites of care.Studies of misuse in medicine have focused on errors made in the hospital. One subset of such errors includes those in which patients are injured as a result of negligence.Probably more important as a cause of overuse is the fact that physicians are often overly enthusiastic believers in the value of the services they provide. Over the past several decades the number of available medical and surgical interventions has increased exponentially. Because physicians derive a great deal of satisfaction from believing that they are able to do good, these newly developed interventions are commonly used in the absence of good evidence to support their efficacy.In addition, American patients are activists and expect their doctors to “do something” about their complaints.
People are also infatuated with technology, often believing that whatever is the newest must be the best. It is therefore often difficult and time consuming for physicians to convince patients that the best treatment for them may be to avoid tests, procedures, and medications and to instead rest and let some time pass. Furthermore, doctors may fear that if they do not act and something unexpected goes wrong, patients may sue.
After reading over some of the problems with care, I also read through some articles that spoke on the improvement of care. It made me think that american car makers, banks and manufactures of consumer electronics have all made emormous improvements in the quality of their products and services in the past ten to fifteen years, so does that mean we can expect the same evolution in health care? Personally I believe we hvae to over come certain obstacles that stand in the way.
Improving quality begins by defining excellent care for a condition or problem, a task that requires marshaling evidence from the research literature about the effectiveness of various treatments, adding expert judgment to the limited evidence base, and distilling this knowledge into clinical practice guidelines, detailed statements about what should and should not be done.20 Guidelines must be put to work to measure current practice. Then we must define shortfalls in quality, ascertain their causes, design and implement interventions and assess their impact, and sustain and enhance improvements.
Another obstacle is the difficulty of justifying the substantial expenditures the effort requires to chief financial officers as investments that are highly likely to produce financial returns. In short, the “business case” for quality improvement in health care is elusive. This predicament would be unfamiliar to those in business who have used a variety of techniques to improve quality and profitability at the same time. Most businesses have strong and consistent financial incentives to improve the quality of their products and services but
the same does not happen so uniformly in health care.
Another obstacle we face is a lack of demand for improvement. One might argue that even if broad-scale quality improvement cannot be supported by convincing return on investment calculations, it might be undertaken if consumers and their representatives were clamoring for it. Despite the volume of data documenting serious health care quality problems and the harm they do, providers experience little demand from consumers for substantial improvement in performance. Although consumers express concern about quality in general, the large majority rely on friends and family to recommend doctors and hospitals; they do not demand that providers produce evidence of better clinical quality or better health outcomes.
In conclusion, Some benefits fewer errors, improvements in the delivery of effective care, and reductions in unnecessary services are within the grasp of the comprehensive improvement effort we envision. Other benefits such as enhanced revenue, and increases in market share are not guaranteed. The time for consumer and providers need to step forward is now in order for changes to be made and obstacles to be knocked over.
1.www.abms.org/who_we_help/physicians/improving_quality.aspx
2.books.google.com › Medical › Administration
3.http://www.youtube.com/watch?v=nPdLqI_UPuI
Extensive research has documented that all three forms of clinical quality problems—underuse, overuse, and misuse—are ubiquitous in American medicine and deserve urgent attention.Substantial underuse of effective interventions pervades the delivery of preventive care, acute care, and chronic care; it occurs across age groups, reimbursement schemes, geographic regions, and sites of care.Studies of misuse in medicine have focused on errors made in the hospital. One subset of such errors includes those in which patients are injured as a result of negligence.Probably more important as a cause of overuse is the fact that physicians are often overly enthusiastic believers in the value of the services they provide. Over the past several decades the number of available medical and surgical interventions has increased exponentially. Because physicians derive a great deal of satisfaction from believing that they are able to do good, these newly developed interventions are commonly used in the absence of good evidence to support their efficacy.In addition, American patients are activists and expect their doctors to “do something” about their complaints.
People are also infatuated with technology, often believing that whatever is the newest must be the best. It is therefore often difficult and time consuming for physicians to convince patients that the best treatment for them may be to avoid tests, procedures, and medications and to instead rest and let some time pass. Furthermore, doctors may fear that if they do not act and something unexpected goes wrong, patients may sue.
After reading over some of the problems with care, I also read through some articles that spoke on the improvement of care. It made me think that american car makers, banks and manufactures of consumer electronics have all made emormous improvements in the quality of their products and services in the past ten to fifteen years, so does that mean we can expect the same evolution in health care? Personally I believe we hvae to over come certain obstacles that stand in the way.
Improving quality begins by defining excellent care for a condition or problem, a task that requires marshaling evidence from the research literature about the effectiveness of various treatments, adding expert judgment to the limited evidence base, and distilling this knowledge into clinical practice guidelines, detailed statements about what should and should not be done.20 Guidelines must be put to work to measure current practice. Then we must define shortfalls in quality, ascertain their causes, design and implement interventions and assess their impact, and sustain and enhance improvements.
Another obstacle is the difficulty of justifying the substantial expenditures the effort requires to chief financial officers as investments that are highly likely to produce financial returns. In short, the “business case” for quality improvement in health care is elusive. This predicament would be unfamiliar to those in business who have used a variety of techniques to improve quality and profitability at the same time. Most businesses have strong and consistent financial incentives to improve the quality of their products and services but
the same does not happen so uniformly in health care.
Another obstacle we face is a lack of demand for improvement. One might argue that even if broad-scale quality improvement cannot be supported by convincing return on investment calculations, it might be undertaken if consumers and their representatives were clamoring for it. Despite the volume of data documenting serious health care quality problems and the harm they do, providers experience little demand from consumers for substantial improvement in performance. Although consumers express concern about quality in general, the large majority rely on friends and family to recommend doctors and hospitals; they do not demand that providers produce evidence of better clinical quality or better health outcomes.
In conclusion, Some benefits fewer errors, improvements in the delivery of effective care, and reductions in unnecessary services are within the grasp of the comprehensive improvement effort we envision. Other benefits such as enhanced revenue, and increases in market share are not guaranteed. The time for consumer and providers need to step forward is now in order for changes to be made and obstacles to be knocked over.
1.www.abms.org/who_we_help/physicians/improving_quality.aspx
2.books.google.com › Medical › Administration
3.http://www.youtube.com/watch?v=nPdLqI_UPuI
Sunday, February 5, 2012
Patient Protection Act
The Patient Protection Act of 2010 is the major health care reform bill, signed into law by President Obama on March 23, 2010. It would expand health care coverage to 31 million currently uninsured Americans through a combination of cost controls, subsidies and mandates. It is estimated to cost $848 billion over a 10 year period, but would be fully offset by new taxes and revenues and would actually reduce the deficit by $131 billion over the same period. The Patient Protection and Affordable Care Act includes:
1) Creation of a new insurance marketplace, resulting in expanding access to coverage
and the formation of state‐based Exchanges
2) Sweeping insurance market reforms
3) Fundamental changes to Medicare, expansion of the Medicaid Program, and reforms
to Part D, closing the “Donut Hole” by 2020
4) Fraud and abuse, health IT, and prevention and wellness initiatives, including the
promotion of prevention programs across the health care system.
After reading about the Patient Protection Act I feel like it was a good idea but do not believe everyone will abide by it. Even though the bill stated everyone requires health insurance but still everyone cannot afford health insurance. It seemed to improve public programs such as medicaid and children's insurance such as CHIP. For health care facilities Medicaid Disproportionate Share Hospital (DSH) Payments it reduces state disproportionate share hospital (DSH) allotments, except for Hawaii, by 50% or 35% once a state's uninsurance rate decreases by 45%, depending on whether they have spent at least or more than 99.9% of their allotments on average during FY2004-FY2008. Requires a reduction of only 25% or 17.5% for low DSH states, depending on whether they have spent at least or more than 99.9% of their allotments on average during FY2004-FY2008. Prescribes allotment reduction requirements for subsequent fiscal years. Revises DSH allotments for Hawaii for the last three quarters of FY2012 and for FY2013 and succeeding fiscal years.With the act, it now allows these facilities to have to meet specific performance standards for a certain performance period. It allows the hospitals to be able provide to the government that they are doing a satifactory quality measures. I also like the fact that they get penalized for not providing a quality measures satisfactorily, beginning in 2015.
en.wikipedia.org/wiki/Patient_
dpc.senate.gov/healthreformbill/
www.cuindependent.com/.../cu-students-
1) Creation of a new insurance marketplace, resulting in expanding access to coverage
and the formation of state‐based Exchanges
2) Sweeping insurance market reforms
3) Fundamental changes to Medicare, expansion of the Medicaid Program, and reforms
to Part D, closing the “Donut Hole” by 2020
4) Fraud and abuse, health IT, and prevention and wellness initiatives, including the
promotion of prevention programs across the health care system.
After reading about the Patient Protection Act I feel like it was a good idea but do not believe everyone will abide by it. Even though the bill stated everyone requires health insurance but still everyone cannot afford health insurance. It seemed to improve public programs such as medicaid and children's insurance such as CHIP. For health care facilities Medicaid Disproportionate Share Hospital (DSH) Payments it reduces state disproportionate share hospital (DSH) allotments, except for Hawaii, by 50% or 35% once a state's uninsurance rate decreases by 45%, depending on whether they have spent at least or more than 99.9% of their allotments on average during FY2004-FY2008. Requires a reduction of only 25% or 17.5% for low DSH states, depending on whether they have spent at least or more than 99.9% of their allotments on average during FY2004-FY2008. Prescribes allotment reduction requirements for subsequent fiscal years. Revises DSH allotments for Hawaii for the last three quarters of FY2012 and for FY2013 and succeeding fiscal years.With the act, it now allows these facilities to have to meet specific performance standards for a certain performance period. It allows the hospitals to be able provide to the government that they are doing a satifactory quality measures. I also like the fact that they get penalized for not providing a quality measures satisfactorily, beginning in 2015.
en.wikipedia.org/wiki/Patient_
dpc.senate.gov/healthreformbill/
www.cuindependent.com/.../cu-students-
Sunday, January 29, 2012
The relationship between the quality of patient-centered care in the context of organizational culture.
In recent years, patient-centered care and cultural competence have been promoted as integral to improving health care quality. Although patient-centered care and cultural competence have grown out of separate traditions, each with its own focus have many similarities. Health care that is patient-centered is likely also to be culturally competent, and culturally competent care is likely to be patient-centered. Proponents of patient centered care may therefore view cultural competence as within its purview; likewise, proponents of cultural competence may view patient centered care as an essential element.
The term “patient-centered medicine” was to express the belief that each patient “has to be understood as a unique human being.The concept has evolved and expanded, and today, no one would deny that health care should be patient-centered.However, despite universal endorsement of patient-centered care,there is considerable ambiguity in its definition and use across settings.
The Picker–Commonwealth Program for Patient-Centered Care began in 1987 to promote a patient-centered approach to hospital and health services focusing on the patient’s needs and concerns.Seven dimensions of patient-centered care were identified as respect for patients’ values, preferences, and expressed needs; coordination and integration of care; information, communication, and education; physical comfort; emotional support and alleviation of fear and anxiety; involvement of friends and family; and transition and continuity. The program clearly went beyond the more narrow interpretation of patientcenteredness as a way for physicians to interact with patients, and moved toward a more comprehensive way of delivering health services.The term “patient-centered care” is not limited to communication and often focuses on other aspects of care such as availability of office hours, ability to get appointments when needed, being seen on time for appointments, and having conveniently located services.
The issue of cultural competence in health care emerged later than did patient centered care .Within the past 10 years, myriad programs addressing cultural competence in health care have been developed, national standards for health care systems have been published, a recurring national conference has been established, and federal mandates to increase cultural competence have been issued. The primary impetus for the cultural competence movement of the past decade has been the demonstration of widespread racial and ethnic disparities in health care, and the consequent publicity surrounding this issue. However, the principles of cultural competence are rooted in efforts that precede the high visibility the issue has received in recent years.For decades, health care leaders and educators have recognized that cultural and linguistic barriers between health care providers and patients can interfere with the effective delivery of services. Greater attention to these barriers gave rise to programs and curricula bearing the monikers “cross-cultural medicine,” “cultural sensitivity,” “transcultural nursing,” and “multicultural counseling.” Programs largely focused on “whose health beliefs may be at variance with biomedical models.”
Although the principles underlying these programs were considered applicable to patients of all backgrounds, they targeted primarily immigrant or refugee populations with limited English proficiency and exposure to Western cultural norms.The expansion of the scope of cultural competence was driven largely by events that revealed racial disparities both in health status and in the quality of health care in the United States.One of these events was the 1985 publication of the Department of Health and Human Services Secretary’s report on black and minority health, which documented substantial and pervasive disparities in the health of people of color, particularly African Americans, as compared with the white population. During the 1990s, these disparities became a central focus under the Clinton Administration.
At the core of both patient centered care and cultural competence is the ability of health care providers to see patients as unique individuals; to maintain unconditional positive regard; to build effective rapport; to use the biopsychosocial model; to explore patient beliefs, values, and meaning of illness; and to find common ground regarding treatment plans. The patient-centered model for patient–physician interactions, in addition, includes a detailed set of knowledge and skills that health care providers should possess. Proponents of cultural competence often make reference to the patient-centered approach when suggesting methods of interaction between patients and physicians. Thus, while these characteristics are not explicitly the focus of cultural competence, most can be endorsed as being aspects of cultural competence.Because the cultural competence and patient-centered care movements both aim to improve health care quality in similar ways, there has been debate about whether it is better to keep the movements separate or combine efforts into a single agenda.
While many features are similar, important aspects of each remain that have not been formally adopted by the other.Cultural competence and patient centered care are both important considerations when thinking about high-quality relationships in health care and health care delivery systems. Patient-centered care has broadly focused on the needs of individual patients, while cultural competence has historically focused on the specific needs of people and communities of color. Although separate movements with separate focuses, both patient centered care and cultural competence may look fairly similar in practice.In the end they recommend that patient centered care and cultural competence remain distinct but aligned efforts to both elevate and balance the quality of health care for all patients.
references:
1) Balint E. The possibilities of patient-centred medicine. J R Coll Gen Pract 1969; 17:269-
276.
2) Lipkin M, Jr., Quill TE, Napodano RJ. The medical interview: a core curriculum for
residencies in internal medicine. Ann Intern Med 1984; 100(2):277-284.
3) Mead N, Bower P. Patient-centeredness: a conceptual framework and review of the
empirical literature. Soc Sci Med 2000; 51(7):1087-1110.
4) American Medical Association. Cultural Competence Compendium. Chicago: American
Medical Association; 1999.
The term “patient-centered medicine” was to express the belief that each patient “has to be understood as a unique human being.The concept has evolved and expanded, and today, no one would deny that health care should be patient-centered.However, despite universal endorsement of patient-centered care,there is considerable ambiguity in its definition and use across settings.
The Picker–Commonwealth Program for Patient-Centered Care began in 1987 to promote a patient-centered approach to hospital and health services focusing on the patient’s needs and concerns.Seven dimensions of patient-centered care were identified as respect for patients’ values, preferences, and expressed needs; coordination and integration of care; information, communication, and education; physical comfort; emotional support and alleviation of fear and anxiety; involvement of friends and family; and transition and continuity. The program clearly went beyond the more narrow interpretation of patientcenteredness as a way for physicians to interact with patients, and moved toward a more comprehensive way of delivering health services.The term “patient-centered care” is not limited to communication and often focuses on other aspects of care such as availability of office hours, ability to get appointments when needed, being seen on time for appointments, and having conveniently located services.
The issue of cultural competence in health care emerged later than did patient centered care .Within the past 10 years, myriad programs addressing cultural competence in health care have been developed, national standards for health care systems have been published, a recurring national conference has been established, and federal mandates to increase cultural competence have been issued. The primary impetus for the cultural competence movement of the past decade has been the demonstration of widespread racial and ethnic disparities in health care, and the consequent publicity surrounding this issue. However, the principles of cultural competence are rooted in efforts that precede the high visibility the issue has received in recent years.For decades, health care leaders and educators have recognized that cultural and linguistic barriers between health care providers and patients can interfere with the effective delivery of services. Greater attention to these barriers gave rise to programs and curricula bearing the monikers “cross-cultural medicine,” “cultural sensitivity,” “transcultural nursing,” and “multicultural counseling.” Programs largely focused on “whose health beliefs may be at variance with biomedical models.”
Although the principles underlying these programs were considered applicable to patients of all backgrounds, they targeted primarily immigrant or refugee populations with limited English proficiency and exposure to Western cultural norms.The expansion of the scope of cultural competence was driven largely by events that revealed racial disparities both in health status and in the quality of health care in the United States.One of these events was the 1985 publication of the Department of Health and Human Services Secretary’s report on black and minority health, which documented substantial and pervasive disparities in the health of people of color, particularly African Americans, as compared with the white population. During the 1990s, these disparities became a central focus under the Clinton Administration.
At the core of both patient centered care and cultural competence is the ability of health care providers to see patients as unique individuals; to maintain unconditional positive regard; to build effective rapport; to use the biopsychosocial model; to explore patient beliefs, values, and meaning of illness; and to find common ground regarding treatment plans. The patient-centered model for patient–physician interactions, in addition, includes a detailed set of knowledge and skills that health care providers should possess. Proponents of cultural competence often make reference to the patient-centered approach when suggesting methods of interaction between patients and physicians. Thus, while these characteristics are not explicitly the focus of cultural competence, most can be endorsed as being aspects of cultural competence.Because the cultural competence and patient-centered care movements both aim to improve health care quality in similar ways, there has been debate about whether it is better to keep the movements separate or combine efforts into a single agenda.
While many features are similar, important aspects of each remain that have not been formally adopted by the other.Cultural competence and patient centered care are both important considerations when thinking about high-quality relationships in health care and health care delivery systems. Patient-centered care has broadly focused on the needs of individual patients, while cultural competence has historically focused on the specific needs of people and communities of color. Although separate movements with separate focuses, both patient centered care and cultural competence may look fairly similar in practice.In the end they recommend that patient centered care and cultural competence remain distinct but aligned efforts to both elevate and balance the quality of health care for all patients.
references:
1) Balint E. The possibilities of patient-centred medicine. J R Coll Gen Pract 1969; 17:269-
276.
2) Lipkin M, Jr., Quill TE, Napodano RJ. The medical interview: a core curriculum for
residencies in internal medicine. Ann Intern Med 1984; 100(2):277-284.
3) Mead N, Bower P. Patient-centeredness: a conceptual framework and review of the
empirical literature. Soc Sci Med 2000; 51(7):1087-1110.
4) American Medical Association. Cultural Competence Compendium. Chicago: American
Medical Association; 1999.
Saturday, January 21, 2012
Phoenix Fire CO2 Incident Review
VIDEO SUMMARY:
The Phoenix Fire CO2 Incident was originally from a call from McDonalds about a pregnant woman who tripped and fell coming up the stairs, but instead the first responders found out that she had fell because of the fumes of CO2. They later discovered that the CO2 leaked from the soda machines. The team uncovered the co2 had leaked so much that it filled the entire basement and the entire basement was filled with co2. The air meter (serius meter) showed that there was a decrease in oxygen, and when the team went further down into the basement the alarm on the air meter was triggered showing to the entry team, that there was 100% gas in the basement.
One of the entry team member noticed that there was a co2 detector with tape on it which is why the co2 detector never went off. The team also realized that the co2 tank did not provide emrgency notices of how to turn the container off. The entry team set up a confined space fan to clean up the co2 gas. After consulting with the manufacturer, it was discovered that the co2 is presumed to be a natural gas in its natural state, with no chemicals which is why the team sirus meter stated that there was 100% natural gas, presenting a false positive. The video also stated that alot of the restaurants are switching over to the co2 liquid tanks, and they believe it would cause alot more harm than help. The video link advises that co2 is an oxygen displacer, and alot of hazards can occur becasue when you lose oxygen and start breathing in co2, it will cause increase in heart rate, light headedness and the individual could fall asleep from lack of oxygen an eventually die from lack of oxygen.
REFLECTIONS:
After reviewing the video, it makes me acknowledge my surroundings more. I say that to state for example, if I smell something strange, I probably would not overlook it as if I normally would. I presume that is what the employee did. Also the video makes you contemplate whether or not fast food industries takes the time check hazard chemicals such as CO2 on a regular basis. It makes you suspect that if they did not show or have any concern for one of their fellow employees then it makes you wonder what if this would have happened to a customer? This video makes you wonder about health inspections that check on fast food industries that determines a grade for them. Is it not in their criteria to grade on checking hazardous chemicals? It puts you in an unsafe enviornment and the fast food industries are suppose to be family friendly. Now the transition is happening where the fast food industry is switching over to liquid CO2 containers, and with all the neglegence that they show with food, it makes me feel like, this is not going to be the first time america is going to see an incident occur.
This story corresponds to another situation of a CO2 leak:
http://www.reuters.com/article/2011/09/14/us-mcdonalds-death-idUSTRE78D7U120110914
The Phoenix Fire CO2 Incident was originally from a call from McDonalds about a pregnant woman who tripped and fell coming up the stairs, but instead the first responders found out that she had fell because of the fumes of CO2. They later discovered that the CO2 leaked from the soda machines. The team uncovered the co2 had leaked so much that it filled the entire basement and the entire basement was filled with co2. The air meter (serius meter) showed that there was a decrease in oxygen, and when the team went further down into the basement the alarm on the air meter was triggered showing to the entry team, that there was 100% gas in the basement.
One of the entry team member noticed that there was a co2 detector with tape on it which is why the co2 detector never went off. The team also realized that the co2 tank did not provide emrgency notices of how to turn the container off. The entry team set up a confined space fan to clean up the co2 gas. After consulting with the manufacturer, it was discovered that the co2 is presumed to be a natural gas in its natural state, with no chemicals which is why the team sirus meter stated that there was 100% natural gas, presenting a false positive. The video also stated that alot of the restaurants are switching over to the co2 liquid tanks, and they believe it would cause alot more harm than help. The video link advises that co2 is an oxygen displacer, and alot of hazards can occur becasue when you lose oxygen and start breathing in co2, it will cause increase in heart rate, light headedness and the individual could fall asleep from lack of oxygen an eventually die from lack of oxygen.
REFLECTIONS:
After reviewing the video, it makes me acknowledge my surroundings more. I say that to state for example, if I smell something strange, I probably would not overlook it as if I normally would. I presume that is what the employee did. Also the video makes you contemplate whether or not fast food industries takes the time check hazard chemicals such as CO2 on a regular basis. It makes you suspect that if they did not show or have any concern for one of their fellow employees then it makes you wonder what if this would have happened to a customer? This video makes you wonder about health inspections that check on fast food industries that determines a grade for them. Is it not in their criteria to grade on checking hazardous chemicals? It puts you in an unsafe enviornment and the fast food industries are suppose to be family friendly. Now the transition is happening where the fast food industry is switching over to liquid CO2 containers, and with all the neglegence that they show with food, it makes me feel like, this is not going to be the first time america is going to see an incident occur.
This story corresponds to another situation of a CO2 leak:
http://www.reuters.com/article/2011/09/14/us-mcdonalds-death-idUSTRE78D7U120110914
Tuesday, December 6, 2011
Discuss efforts (particularly during the Clinton and George W. Bush Administrations) to improve productivity in the agencies of the federal government of the United States in the context of the notion of "dichotomy" in the historic public administration literature
After reading and researching the topic that was given to us, it seems that during the Clinton – Bush era, a dichotomy did not exist. Personally, it seems that the two had word together to accomplish the same goal. I say this because during this time, both republicans and democrats agreed with how their elected officials ran the government. By the two working together seemed to improve productivity in the agencies of the federal government of the United States.
During the Clinton administration, his ideas were significantly influenced by the New Public Management (NPM). The NPM was a trend that surfaced in Europe and Oceania during the 1990s. One of the key components of NPM was acknowledging citizens as customers. The case for this strategy rested on the fact that more local government services were becoming “ fee- for – services” based, and citizens in general were demanding a level of service quality , one equivalent to the one that was provided by private sectors. Clinton reinvented the federal government by altering the ways in which the federal government conducted its affairs and interactions with the “customers” (citizens) they served. Under the Clinton administration, he created the National Performance Review which incorporated reinventing government principles and exhorted federal agencies to downsize, eliminate unnecessary regulations, focus on results, and offer customer service equal to or better than “the best in business.” The NPR goals included:
1. Employee empowerment
2. Restructure and “do more with less”
3. Performance budgeting
4. Enhance use of information technology
5. Identified performance goals and set customer service standards.
During the Bush administration, the use of data to make budgetary and programmatic decisions became the foundation of the President’s Management Agenda (PMA). The PMA was the Bush administration plan for the federal government. Under the Bush administration, private alternatives such as competitive outsourcing were favored as a performance management measure. President Bush espoused competition and privatization as the best option to overcome bureaucratic resistance. Under the PMA, federal agencies were required to show how public programs achieve results more efficiently than other methods, such as faith – based, private, or nonprofit alternatives. The MPA goals included:
1. Strategic management of human capital
2. Competitive sourcing – privatization
3. Improved financial performance
4. Expanded electronic government
5. Budget and performance integration (GPRA)
Under both the Bush and Clinton administration efforts had a citizen/customer focus and emphasized a greater use of electronic government. The Clinton electronic government effort spawned the Government Paperwork Elimination Act and hundreds of innovative web projects. The Bush effort winnowed those efforts to 24 that had the potential for significant changes in government (such as an electronic travel system), for citizens (such as a common portal for federal benefits), and for businesses (such as a common portal for all regulations affecting businesses). It extended its efforts via the E-Government Act of 2002. Both reform efforts also placed greater attention on improving program performance and obtaining results. While the Clinton reform effort undertook the initial implementation of the Government Performance and Results Act, which created a new supply of performance information, the Bush administration systematically attempted to leverage that information to improve agency performance and increase accountability for results. Both administrations, after several years of top-down recommendations and initiatives, shifted to more of a support role in which they worked with senior agency leaders to develop initiatives and performance targets jointly. This led to greater ownership by agency-level political appointees. Together, both reform efforts shared a number of common recommendations on improving financial management, strengthening human capital, and achieving budget reform. Efforts begun under Clinton were more concretely implemented under Bush. Interestingly, both also encountered challenges in explaining the results and value of their effort to the public.
Despite these similarities, the Clinton and Bush reforms displayed a number of important differences, especially in their implementation. Clinton’s initial six month Performance Review generated over 1200 recommendations. By sheer volume, some thought it discredited itself. There were enough idealistic ideas in the initial set of recommendations that those naturally opposed to real reform used them to impugn the credibility of the entire effort. In addition, the Clinton effort continued to generate initiatives and recommendations during the course of the entire eight-year effort. It issued over 100 reports and publications. Bush’s Management Agenda, on the other hand, focused on a few large ideas that represented long-standing, well-known management challenges. The Bush administration doggedly focused on the implementation of these core elements for its entire eight years and added or deleted relatively few items from its Management Agenda.
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