Managing change in the context of health reform: lessons from Alberta.

A qualitative field study of health system reform in Alberta was undertaken to identify, describe, compare and contrast the processes of change management adopted and implemented as a result of legislated health policy shift. Chairs and chief executives of the new regional health authorities and provincial leaders managing the change processes within Alberta's health care system were interviewed. Components of change strategies important to the structure, process and impact of the health policy shift to a regionalized system of care were identified and analyzed. Stakeholders involved in managing change inside Alberta's health care system were able to consistently identify a range of issues important to beginning and sustaining health policy shift. These issues and insights did not come from the literature, but rather from experience. To test and share this experience further, it will be important to study more consciously the management of change in relation to expected outcomes. With so many natural experiments altering health care systems across Canada and beyond, a window of opportunity exists for researching both the quality and quantity of such change, comparing and sharing findings over time and, eventually, linking process to outcome.

Transforming information: data management support of health care reorganization.

Health care delivery systems and organizations around the world are undergoing reorganization and reengineering. Rational decision making about such activities must be based on information. Much of the presently available data is inadequate for this task, and therefore needs to be transformed. One such experience in the province of Alberta, Canada, is discussed. The development of a comprehensive information strategy, the need to apply information management principles, the organizational implications of information management, and a conceptual model for achieving added value from health data are described.

A risk management approach to the security of hospital information systems.

Risk management in today's technologically advanced health care system demands proactive rather than reactive strategies. Risk management is defined as a planned program for liability control and involves the identification, analysis and evaluation of legal risks followed by strategies to reduce or eliminate these risks. The concept of risk management is most often associated with quality assurance and direct patient care activities. For current purposes, the risk management concept is borrowed from arena of patient care and applied to the security measures surrounding hospital information systems. In this context, risk management/liability control is viewed as proactive activities designed to protect both the hospital information system and the confidentiality of patient information.

A Canadian nursing minimum data set: a major priority.

Through a selected review of existing hospital and health care minimum data sets in the United States, the United Kingdom and Canada, the authors expose the nursing data gaps in those data sets. Nurses in the United States have responded to these data gaps through the development of a Nursing Minimum Data Set (NMDS). The NMDS is a tool for abstracting a uniform collection of essential nursing data from the patient record usually at hospital discharge. The nursing care data elements in the NMDS include: nursing diagnosis, nursing intervention, nursing outcome, and intensity of nursing care. A major factor influencing the move to generate an NMDS in Canada is the response to the need to contain rising health care costs while maintaining quality health care. The NMDS has profound implications for nurses in all practice settings through use of these data in: costing of nursing services; defending resource allocation to nursing; defining nursing's contribution to patient care; defining outcomes of nursing care; developing nursing knowledge; and continued growth of nursing as a profession. Initiatives in Canada directed at the development of an NMDS indicate a heightened awareness of the need for the collection, storage and retrieval of nursing data. However, nurses in Canada have yet to define the essential nursing data elements for inclusion in a national health information system for use in Canada.

Integrating a nursing professional practice model and nursing informatics in a collective bargaining environment.

The integration of a professional practice model of nursing and nursing informatics support for that model is congruent with the goals of a professional nursing union. Thus, the collective-bargaining unit can be a powerful ally to nursing management in achieving the integration of a professional practice model of nursing and nursing informatics. This alliance is based on a shared vision of the nature of professional nursing practice and a common concern for the quality of working life and working environment of the professional nurse. This alliance can provide the basis for decision making about the type of nursing information system to be selected or developed for installation in a particular organization. Use of a participatory decision-making process will ensure that all nursing stakeholders are committed to the decision made and prepared to assist with the resolution of implementation issues as they arise. A harmonious alliance of nursing management and the nursing union ensures a partnership that will protect the clinical nursing caregiver and provide a unified voice for nursing within the organization to resist any attempt by other stakeholders to implement an information system that will not meet the needs of nursing. If nursing management and the collective bargaining unit share the concept of a professional model of nursing practice and view nursing informatics as a tool to assist the nursing staff to operationalize the professional model of nursing, then collaboration in resolving issues related to the implementation of nursing information systems will facilitate the process of achieving the integration of a professional practice model of nursing and nursing informatics support for that model.

Computer applications for staff development and patient education.

The changing and evolving profession of nursing necessitates extensive staff development activities on the part of nursing management. This ongoing responsibility is essential to maintaining the currency and competence of practicing nurses and facilitating their professional growth. Simultaneously there are economic constraints coinciding with increased consumer demands for patient education. The purpose of this paper is to explore an innovative teaching method, the use of instructional computing for staff development and patient education programs. The theoretical frameworks for this instructional modality are identified and general advantages and disadvantages of instructional computing applications are described. Specific examples of programs from the literature are briefly discussed.

Body temperature in elderly surgical patients.

Body temperatures of 37 elderly surgical patients with fractured hips were measured using tympanic membrane probes. Comparisons were made between patients having the usual body coverings, eight were hypothermic as compared with one of 16 patients with extra body coverings. Temperatures were significantly different between groups intraoperatively (p less than .001) and in the recovery room p less than .002) where the lowest temperatures were recorded. Anxiolytics given preoperatively had a significant negative relationship with lower body temperatures. Careful monitoring of temperatures and extra coverings are recommended for elderly hip fractured patients perioperatively.

The case for using computers in the operating room.

The largest cost center and revenue generator in most hospitals, the operating room is subject to demands for increased cost accountability and quality assurance. Information technology tools can be incorporated into the operating room and have the potential to positively affect practices there through addressing nursing, administrative/financial and medical needs. Microcomputer-based operating room systems now on the market can provide functions from scheduling and case costing to medical records and market analysis. Of 21 functions identified, 10 can be characterized as mandatory and the remaining as optional. Individual systems offer varied configurations, providing from 0 to 21 functions. These enhanced capabilities for data collection, monitoring and analysis enable health care professionals to provide both better and more cost-effective care for surgical patients.

Hyperoxia: effects on the vascularization of the developing central nervous system.

Litters of experimental and control hamsters were killed on postnatal days 3, 4, 7, 14, 21, and 28 following 7 days of exposure to 85% oxygen at normabaric pressure. Using analysis of variance (ANOVA), light microscopy quantitation of the number of blood vessel profiles per unit area in the region of the frontal cerebral cortex demonstrated that the combined effect of treatment and age on the animals produced a highly statistically significant difference (p less than 0.001) in the numbers of blood vessel profiles. The statistically separated treatment effect was also found to be significant (P less than 0.05). The data are summarized in Table 1. Ultrastructural analysis of animals exposed to oxygen only, i.e., killed without being returned to the normal air environment, demonstrated severe signs of vaso-obliteration. Animals which were returned to a normal atmosphere following 7 days in oxygen showed a progressive decrease in the signs of vaso-obliteration. This present study demonstrated the marked similarity between the effects of hyperoxia on he CNS and on the neuro-retina.