Search results

Suggests that the US health‐care environment is undergoing major changes, raising a number of challenges for health‐care organizations. Not only must they build and retain massive networks of patient information, cost analysis, managed care, physicians, they must also maintain responsiveness to the dynamic market conditions. Discusses how health‐care providers faced with this mammoth task, have sought to embrace an innovative information technology infrastructure to reduce cost, streamline operations, and provide better service for the patient.

This article discusses the perils of electronic communication, the regulators' response to its proliferation, the findings of a recent survey by Orchestria, and the traditional solutions most companies are adopting.

Discusses results of a survey that illustrates the uncontrollable nature of electronic communication; recent financial services regulations concerning document retention, activity supervision, and communication approval; archiving and other costs of electronic communication; the inadequacy of many companies' risk mitigation strategies; and a recommended active policy management approach.

The challenge that management and compliance staff face with unstructured communication is twofold: 1. the speed and informality with which messaging systems are used by employees to make assertions and promises and to transfer data, and 2. the almost total absence of management visibility and control over the content of such communications. In the current regulatory climate, not knowing what employees are communicating to each other, clients, suppliers, and other contacts is a significant risk.

Alerts financial services companies to the risks inherent in employees' unrestricted use of all the different electronic communications media and recommends a proactive approach to manage those risks.

The purpose of this paper is to describe a new methodology called E‐thics, how it can be applied to an investment company, and how it can be used as a catalyst to develop an ethical corporate culture.

Discusses recent events that have led the general public to expect improved corporate behaviour; what compels companies toward ethical behaviour; recent legislation designed to prevent the harm caused by corruption, greed, and fraud; how ethics are turned into E‐thics; and the apparatus, promise, and limitations of E‐thics.

E‐thics applies policy‐based review and control to electronic communication. It acts like a virtual conscience, sitting on the edge of all your computer screens. An effective E‐thics system should detect all messages that contain breaches of ethics and also should educate the sender about the nature of the breach and other corrective instructions. E‐thics requires the full participation of everyone in the firm, not just lip service. Its greatest value may be that it will act as a catalyst for the evolution of a corporate culture based on shared ethical values, fairness, responsibility, and stewardship. E‐thics can help the investment community move from a culture of compliance to one of true ethics.

While recommending a system to screen potential harmful electronic messages, an explanation is also given as to how such a system can fit into a broader effort to develop an ethical corporate culture.

Using material from contemporary New Zealand experience as a case study, this paper presents a functional analysis of the organizational problems facing secondary schools, develops a typology of dilemmas posed as a result of these problems, and discusses the manner in which various educational agencies, including the central Department, Teachers' Organizations and the recent Educational Development Conference have attempted to persuade schools to resolve these dilemmas in particular ways. Comments are also made on the internal characteristics of schools which may influence their resolution of these dilemmas in different ways thus leading to a growing heterogeneity within the state educational system.

The purpose of this paper is to offer six principles that health system leaders can apply to establish a governance and management system for the quality of care and patient safety.

Leaders of a large academic health system set a goal of high reliability and formed a quality board committee in 2011 to oversee quality and patient safety everywhere care was delivered. Leaders of the health system and every entity, including inpatient hospitals, home care companies, and ambulatory services staff the committee. The committee works with the management for each entity to set and achieve quality goals. Through this work, the six principles emerged to address management structures and processes.

The principles are: ensure there is oversight for quality everywhere care is delivered under the health system; create a framework to organize and report the work; identify care areas where quality is ambiguous or underdeveloped (i.e. islands of quality) and work to ensure there is reporting and accountability for quality measures; create a consolidated quality statement similar to a financial statement; ensure the integrity of the data used to measure and report quality and safety performance; and transparently report performance and create an explicit accountability model.

This governance and management system for quality and safety functions similar to a finance system, with quality performance documented and reported, data integrity monitored, and accountability for performance from board to bedside. To the authors’ knowledge, this is the first description of how a board has taken this type of systematic approach to oversee the quality of care.

In Kenya, gaps exist in health service provision to slum residents, especially service availability and access to quality care. There is also little information on the health status of people living in slums other than in Nairobi. The purpose of this paper is to generate evidence for use in designing interventions to improve health services in four mid-sized slums in Embu, Nyeri and Thika, Kenya.

A cross-sectional survey of clients receiving services in health facilities was conducted in the targeted slums. Data were collected through face-to-face interviews. Factor scores were generated using the Rasch model; simple and multivariate logistic regression analyses were done using the R statistical software.

Overall, 81 per cent of the 203 participants reported being satisfied with health services. Most clients (89 per cent) reported that health facility staff greeted them warmly; 82 per cent said their consultation was private. The facility type, waiting time and client experience with service providers determined their satisfaction (p < 0.05).

Healthcare managers can improve client satisfaction levels by understanding the client flow in their facilities and addressing causes of client dissatisfaction, such as long waiting times, while at the same time promoting facilitating factors.

The authors use latent variable modelling to compute client satisfaction scores, which were dichotomised into two categories and fitted into a logistic regression model to identify factors that influence client satisfaction. Health facility clients in the four slums are satisfied with services and have confidence the providers will serve them in a friendly and professional manner that promotes respect and quality care. The paper recommend healthcare managers in similar settings carry out client flow analysis and institute remedial measures to address long waiting times. Qualitative studies are recommended to determine the reasons behind the high satisfaction levels reported in this study.

The reasons why some people use illicit drugs recreationally and in a dependent, harmful, way are not clearly understood. Various factors have been put forward, each of which may play some part in affecting individual drug using outcomes. Rounsaville (1982), for example, analysed the life records of approximately 400 opiate users and identified two antecedents to drug use, childhood trauma and early antisocial or delinquent behaviour. Social background and deprivation have also been noted as possible preceding factors. Parker et al (1987) found correlations between heroin use and unemployment, overcrowding and other indices of deprivation. Other perspectives on use, cited by Johns (1990), include availability and peer influence. Sub‐culture has also been suggested as an important context to use (Becker, 1963; Williams, 1989). The Third Triennial Report to Congress (Department of Health and Public Service, 1991) focused on individual ‘risks’, which were categorised as biological (genetic), psychological, behavioural (anti‐social and delinquent activies), demographic (such as gender or ethnic factors), and environmental (arising from family or peer group influence). However, despite these and many other perspectives on pathways to illicit drug use and drug‐related harm, a comprehensive account which seeks to ground such practices in the complex interplay between the individual, their community and elements of social structure has yet to be achieved.