ABSTRACT
Although "managed care" means different things to different people, it has become an icon for health care change and is commonly cited as the principle cause for the physician's lament. Successful leaders are finding ways to address the signs, symptoms, and causes of the physician grief reaction to the tumultuous marketplace changes affecting how they view themselves as professionals and how they practice medicine. Health care CEOs continue to place the search for solutions, physician-hospital integration, and the alignment of system and physician incentives as their number one strategic priority. This article reviews common sources of anger and identifies potential solutions. Strategies for dealing with the anger include: (1) recognizing the issues, causes, signs, and symptoms; (2) restoring balance and power; (3) developing new economic partnerships; (4) managing the organizational culture; and (5) educating one another and developing leadership.
Subject(s)
Leadership , Managed Care Programs/organization & administration , Physicians/psychology , Professional Autonomy , Anger , Career Choice , Decision Making, Organizational , Grief , Hospital-Physician Relations , Humans , Interprofessional Relations , Job Satisfaction , Managed Care Programs/economics , Managed Care Programs/standards , Physician-Patient Relations , Power, Psychological , United StatesSubject(s)
Health Facilities/legislation & jurisprudence , Health Facility Merger/legislation & jurisprudence , Hospitals, Voluntary/legislation & jurisprudence , Legislation, Hospital , Cost Control , Economic Competition/legislation & jurisprudence , Hospital Planning/economics , Illinois , United States , United States Federal Trade Commission , VirginiaABSTRACT
In a mail questionnaire to members of the American College of Physician Executives, physician executives were asked to rank and weight the importance of nine elements of a quality definition for each of six clinical scenarios. The scenarios differed in terms of the severity of illness on admission and in terms of outcome. The study suggests that evaluations of quality that do not assess severity of illness may be misleading. The study also demonstrates that some agreement on the relative importance of indicators of quality can be reached.
Subject(s)
Health Services Research , Outcome and Process Assessment, Health Care/trends , Quality of Health Care/standards , Classification , Models, Statistical , Physician Executives , Reference Standards , Research Design , Severity of Illness Index , Surveys and Questionnaires , United StatesABSTRACT
A three and one half-year-old female with Melnick-Needles osteodysplasia is presented. In addition to the characteristic bone roengenograms and obstructive uropathy, the patient had inadequate formation of bone marrow elements and pulmonary arter hypertension.
Subject(s)
Bone Marrow Diseases/complications , Bone and Bones/abnormalities , Hypertension, Pulmonary/complications , Mandibulofacial Dysostosis/complications , Ureteral Obstruction/complications , Child, Preschool , Female , Humans , SyndromeABSTRACT
A 1.7 cm. Björk-Shiley prosthetic valve was successfully inserted into the mitral annulus in a 7-month-old infant weighing 4.5 kilograms. Rapidly progressive pulmonary arteriolar hypertension and heart failure required surgical intervention. Postoperative problems are discussed. This patient's rapid clinical improvement after the operation further indicates that valve replacement is an important therapeutic alternative in carefully selected infants.
