RESUMO
We explore the influence of the Thirteenth Amendment to the US Constitution on the enforceability of personal services contracts for physicians. This influence extends from the ambiguous definition to the legal interpretation of personal services contracts. The courts have struggled with determining contracts to be a personal service and whether to grant injunctions for continued performance. The award or denial of damages due to a breach of contract is vested in these enforceability complications. Because of the Thirteenth Amendment's influence, courts and contracting parties will continue to struggle with physician personal services contract enforceability; although other points of view may exist. Possible solutions are offered for health care contract managers dealing with challenges attributable to physician personal services contracts.
Assuntos
Serviços Contratados/legislação & jurisprudência , Emprego/legislação & jurisprudência , Médicos/legislação & jurisprudência , Setor de Assistência à Saúde/legislação & jurisprudência , HumanosRESUMO
Use of outsourced nurses is often a stop-gap measure for unplanned vacancies in smaller healthcare facilities such as long-term acute-care hospitals (LTACHs). However, the relationship of utilization levels (low, medium, or high percentages) of nonemployees covering staff schedules often is perceived to have negative relationships with quality outcomes. To assess this issue, the authors discuss the outcomes of their national study of LTACH hospitals that indicated no relationship existed between variations in percentage of staffing by contracted nurses and selected outcomes in this post-acute-care setting.
Assuntos
Liderança , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Serviços Terceirizados/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Doença Aguda/terapia , Estudos Transversais , Humanos , Assistência de Longa Duração/organização & administração , Erros de Medicação/estatística & dados numéricos , Pesquisa em Administração de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/provisão & distribuição , Avaliação de Resultados em Cuidados de Saúde , Serviços Terceirizados/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Estados Unidos , Recursos HumanosRESUMO
When staffing effectiveness is not maintained over time, the likelihood of negative outcomes increases. This challenge is particularly problematic in long-term acute care hospitals (LTACHs) where use of outsourced temporary nurses is common when providing safe, sufficient care to medically complex patients who require longer hospital stays than normally would occur. To assess this issue, the authors discuss the outcomes of their survey of LTACH chief nursing officers that demonstrated LTACH quality indicators and overall patient satisfaction were within nationally accepted benchmarks even with higher levels of outsourced nurses used in this post-acute care setting.
