Lutchmie Narine

Gaining and maintaining commitment to large-scale change in healthcare organizations.

Healthcare administrators have sought to improve the quality of healthcare services by using organizational change as a lever. Unfortunately, evaluations of organizational change efforts in areas such as total quality management (TQM), continuous quality improvement (CQI), and organizational restructuring have indicated that these change programmes have not fulfilled their promise in improving service delivery. Furthermore, there are no easy answers as to why so many large-scale change programmes are unsuccessful. The aim of this analysis is to provide insights into practices that may be utilized to improve the chances of successful change management. It is proposed that in order to effect change, implementers must first gain commitment to the change. This is done by ensuring organizational readiness for change, surfacing dissatisfaction with the present state, communicating a clear vision of the proposed change, promoting participation in the change effort, and developing a clear and consistent communication plan. However gaining commitment is not enough. Many change programmes have been initially perceived as being successful but long-term success has been elusive. Therefore, maintaining commitment during the uncertainty associated with the transition period is imperative. This can be done by successfully managing the transition using action steps such as consolidating change using feedback mechanisms and making the change a permanent part of the organizations culture.

A review of organizational performance assessment in health care

As health care organizations look for ways to ensure cost-effective, high quality service delivery while still meeting patient needs, organizational performance assessment (OPA) is useful in focusing improvement efforts. In addition, organizational performance assessment is essential for ongoing management decision-making, operational effectiveness and strategy formulation. In this paper, the roles and impact of OPA models in use in health care are reviewed, and areas of potential abuse, such as myopia, tunnel vision and gaming, are identified. The review shows that most existing OPA models were developed primarily as sources of information for purchasers or consumers, or to enable providers to identify areas for improvement. However, there was little conclusive evidence evaluating their impact. This review of existing OPA models enabled the establishment of principles for the development, implementation and prevention of abuse of OPA specific to health care. The OPA models currently in use in health care may provide managers with false confidence in their ability to monitor organizational performance. To further enhance the field of OPA, areas for future research are identified.

The Temporarily and Chronically Uninsured: Does Their Use of Primary Care Differ?

The purpose of this study is to examine differences in the use of preventive or early-detection services by the temporarily and chronically uninsured. The use of preventive care was measured by an index that depicts the use of nine preventive or early-detection services and the use or nonuse of each procedure on the index. Respondents whose lapse in insurance coverage was one year or more were identified as chronically uninsured, while those whose lapse in coverage was less than one year were identified as temporarily uninsured. The analysis indicates that the chronically uninsured and, to a lesser extent, the temporarily uninsured use significantly fewer preventive or early-detection services than their insured counterparts.

Factors associated with the likelihood of injury resulting from collisions between four-wheel drive vehicles and passenger cars

The specific effects of vehicular type on the likelihood of an injury occurring are relatively unexplored. This study sought to assess the relative risk of injury to occupants of four-wheel drive vehicles and their counterparts in passenger cars. Data for 1143 occupants from all of the 454 crashes in Oklahoma, in 1995 that involved a four-wheel drive vehicle were used. Multiple logistic regression analysis determined the association between potential predictive factors and vehicular injury. Odds ratios revealed occupancy in a passenger car to be a major predictor of the likelihood of injury. Other factors include the driver being female, driving too fast, travel on curved or level roadways, and being hit laterally or from the rear.

Pharmacoeconomic Analysis of Empirical Therapy with Ceftazidime Alone or Combination Antibiotics for Febrile Neutropenia in Cancer Patients

SummaryThere is evidence to suggest that single-agent broad spectrum antibacterials may be cost-effective alternatives to combination antibiotics for the empirical management of febrile neutropenia in cancer patients.The objectives of the present study were 2-fold. The first objective was to compare the clinical effectiveness of ceftazidime monotherapy with that of 2 combination antibiotic regimens in cancer patients with febrile neutropenia. The 2 comparator regimens consisted of tobramycin plus piperacillin, either with (regimen ‘CAP’) or without (regimen ‘AP’) cefazolin. The second objective was to perform a cost-effectiveness analysis of the 3 regimens.Meta-analysis of randomised comparative trials between the 3 therapy groups was performed to determine the average overall response rate after 3 to 5 days of treatment. Seven clinical studies were selected for analysis. The overall incidence of adverse drug reactions (ADRs) was determined using the results of comparative and noncomparative studies. A comparative cost-analytic model was applied from a hospital perspective. The costs of primary therapy, hospitalisation, laboratory tests, routine patient care and treating ADRs were calculated, as were future costs.Monotherapy with ceftazidime was associated with an overall response rate of 63.5% and mean per-patient costs of

Factors contributing to the amount of vehicular damage resulting from collisions between four-wheel drive vehicles and passenger cars.

Can12 000 to

Cost-minimization analysis of treprostinil vs. epoprostenol as an alternate to oral therapy non- responders for the treatment of pulmonary arterial hypertension

Can14 000. In comparison, regimen AP was associated with an overall response rate of 58.8% and mean costs of

Relationships Between Parenting Practices and Preschoolers’ Social Skills in African, Indo, and Mixed-Ethnic Families in Trinidad and Tobago The Mediating Role of Ethnic Socialization

Can 13 000 to

Equity Concerns With the Use of Hospital Services by the Medically Vulnerable

Can 16 000 per patient. The overall response rate in patients receiving CAP was 75.3%, and the mean cost per patient was

Prediction of the financial performance of Ontario hospitals: A test of environmental determinist and adaptationist perspectives

Can 11 000 to