Outcomes and surprises of work redesign.

Work redesign, reengineering, and patient-focused care are terms frequently used to describe various efforts among hospitals to streamline patient-care delivery, create efficiency, and lower costs. No matter what these initiatives are labeled, or what theory guided the change effort, hospitals engaged in these reforms have learned some unexpected lessons. This article describes some surprising outcomes from work redesign.

Measuring performance and outcomes in community hospitals: a case example.

Selection, measurement, and communication of critical indicators of success, for both the patient and the organization, are increasingly important for today's health care agency. Each discipline brings expertise to bear on favorable quality and cost outcomes, including the patient and family. To make strategic decisions on both a micro (patient care) level and macro (organization or system) level, it is necessary to analyze results from a synthesized perspective. Nurse managers, physicians, administrators, governing boards, and payers need data presented via an instrument panel format to create understanding from multiple dimensions.

Reengineering knowledge and skills: essential for nurse managers.

Nurse managers of this decade and beyond face a very different set of performance expectations than they did only 10 years ago. Although many of the previously acquired skills remain useful, there are new skills to be assimilated to enhance organizational and clinical effectiveness. Reengineering is a valuable knowledge tool that nurse managers can put to use across health care settings. Nurse managers become process-owners, and as such can effect substantive positive change within their organizations.

Nurse administrator employment in group practices.

The decline in managerial positions in hospitals has resulted in nurses' increased interest in management opportunities in other healthcare system sectors. This study reports the responses of 963 medical group practices to a survey of educational preferences and support mechanisms for the preparation of administrators for this type of setting. The findings raise issues for nurse managers seeking nonhospital employment and for nursing schools that have defined their educational mission as encompassing the preparation of nurse managers.

The new demand area: nurse practitioners receive numerous job offers.

Demand for nurse practitioners continues to increase. Hospitals, long-term care facilities, out-patient areas, and ambulatory settings cannot find enough qualified applicants for their positions. Schools cannot take all the qualified applicants into their programs because of shortages of faculty or student practice sites. Meanwhile, many nurse practitioners report six or more job offers upon graduation. This author describes this new trend and strategies you can take now to prevent recruitment problems in the future.

Nursing the system. Key users are sometimes "out of the loop".

Among those with a particular interest in hospital information systems are those who teach nursing students at the college level. To get their views, Southern Hospitals interviewed four Nurse Scholars involved with nursing and research projects for universities across the South. In 1989, Atlanta-based vendors HealthQuest and HBO & Company of Georgia established the Nurse Scholars Program in an effort to help academia stay abreast of technology. It provides nurse educators with comprehensive instruction in emerging technologies and uses of automated patient care systems. The scholars are encouraged to share their new knowledge with students, faculty, practitioners and administrators so that future nurse executives will better understand and communicate what they need and want from information systems.

Evaluation of an employee health risk appraisal program.

1. After 2 years of employee participation, a computerized health risk assessment program managed by occupational health nurses was evaluated to determine whether health risk factor levels had undergone any significant change. 2. Data on 387 hospital employees were examined. Statistically significant reductions in risk factor levels were found for diastolic blood pressure, serum cholesterol, and smoking. The risk factor "weight" remained unchanged from year 1 to year 2 for both groups. 3. These findings suggest that the nursing interventions of focused, written feedback on risk factors, private counseling, and risk reduction education classes may have been important in motivating employees to make significant lifestyle changes.