An account of collective actions in public health.

Aggregated health decisions by individuals are of paramount importance to public health professionals and policymakers, especially in situations where collective participation is a prerequisite for achieving an important public health goal such as herd immunity. In such circumstances, concerted action often falls short of the common good through lack of sufficient participation. Collective action problems are traditionally attributed to rational egoists seeking to promote their interests and enjoy a "free ride." We call attention, however, to the behavioral features of collective action and their implications for solving public health policy problems.

[The physician manager--building a clinical leadership in community medicine--the Maccabi Healthcare Services (MHS) model].

Community medicine around the world is facing constant trends of changes. The need to overcome the huge burden of chronic diseases, the need to prioritize and adapt new technologies, and above all, the fact that all these must be done within a given, restricted budget, calls for advanced medical management. In this review we focused on the development of the role of the physician manager in Maccabi Healthcare Services (MHS) over the last 60 years. From what was once a reactive, utilization control-oriented administrative physician role, there has emerged a proactive, formally educated, health quality leader who is expected to lead his clinical colleagues towards achieving the organization's goals. Every organization should answer 4 basic questions in order to encourage/develop the new generation of physician managers. 1. Who am I?--What is the profile and what are the tasks of the physician manager's role? 2. What is the time allocation allotted to the physician manager by the organization to enable him to do his job? 3. What are the educational and managerial tools provided for the 'new" physician manager? 4. What are the rewards that the organization grants to its best people? By addressing the above questions MHS has successfully developed new generations of young clinical leaders who can help MHS management conduct a real dialogue with its clinical physicians in order to maximize the services that our beneficiaries are receiving from the HMO. Our conclusion is that choosing the right people, providing them with the right tools and positioning the physician manager appropriately in the organization's hierarchy will enable the medical care delivery system in Israel to achieve the level of clinical leadership that can lead us towards a better future.

Role of diagnosis-specific information sheets in parents' understanding of emergency department discharge instructions.

OBJECTIVES: To investigate the contribution of diagnosis-specific information sheets at discharge from the emergency department on parental understanding of the discharge instructions. METHODS: The study group consisted of a convenience sample of parents of children discharged home from the emergency department of an urban tertiary care pediatric facility (n=95). At discharge by the physician, all were given a disease-specific information sheet to accompany the physician's discharge instructions. Thereafter, the parents were asked to complete the same 13-item questionnaire used in our previous study, covering demographics, level of anxiety, and quality of physician's explanation, in addition to a description, in their own words, of their child's diagnosis and treatment instruction and an indication of their preferred auxiliary method of delivery of information. The findings were compared with the study group in the first phase study (n=287) who did not receive the disease-specific information sheet. The BMDP statistical package was used for the analysis. RESULTS: No statistically significant differences between the two groups in age, sex, and education, level of anxiety before or after the emergency department visit, or time of day were observed. Full understanding of the diagnosis was noted in 73% of the parents who received the information sheet and 72% of the parents in our previous study who did not. Corresponding rates of understanding of the treatment instructions were 92% and 82%. On statistical analysis, the distribution of the diagnosis-specific information sheet significantly improved parental understanding of the treatment instructions (P=0.025), but not of the diagnosis (P=0.54). CONCLUSIONS: Although overall parental understanding of emergency department discharge instructions is good, understanding of the treatment instructions can be further improved with the use of diagnosis-specific information sheets.