RESUMEN
Victoria Hospital Corporation in London has adopted a collaborative management model that involves the participation of medical, union and non-union staff in the administrative decision-making process within predetermined parameters. Reactions have been favourable from all sides--positive feedback from the groups involved and minimal negative public response to the sensitive decisions made concerning downsizing. Early indicators suggest increasing further the participation of union and non-union staff in decision-making on multiple levels, but with clearly defined "boundaries of responsibility."
Asunto(s)
Toma de Decisiones en la Organización , Reestructuración Hospitalaria/organización & administración , Equipos de Administración Institucional/organización & administración , Relaciones Interprofesionales , Sindicatos , Ontario , Innovación OrganizacionalRESUMEN
The majority of pediatric residents continue to choose a career in practice on completion of their training. Despite knowing residents' career preferences, many training programs have focused on inpatient tertiary care at the expense of primary care. Perhaps this reflects service needs and the significant technology and extensive information resulting in the growth of pediatric subspecialties. To determine the spectrum of didactic and clinical experiences pediatric training programs offer residents to prepare them for managing a practice, we conducted a survey of pediatric training program directors in 1988. Although the majority of residency programs have a practice management curriculum, the number of hours devoted to this area is minimal. In addition, a significant number of residents are not experiencing a community office rotation. This survey indicates the need to develop a practice management curriculum if trainees are to be prepared for choosing the right career and for being competitive in practice.
Asunto(s)
Curriculum , Hospitales de Enseñanza/estadística & datos numéricos , Internado y Residencia/estadística & datos numéricos , Pediatría/organización & administración , Administración de la Práctica Médica , Análisis de Varianza , Recolección de Datos , Docentes Médicos , Visita a Consultorio Médico , Pediatría/educación , Ejecutivos Médicos , Estudios de Tiempo y Movimiento , Estados Unidos , Carga de TrabajoRESUMEN
To evaluate the clinical impression that hemophiliacs express a high level of interest in physical activities associated with a significant risk of major bleeding, a self-administered questionnaire was given to the 17 hemophilic adolescents 11-19 years of age in a state hemophilia program, and to 17 age-matched non-hemophilic adolescents. Scores for risk-taking attitudes, anticipated risk-taking behavior were calculated for 23 activities. Compared with controls, hemophiliacs neither express greater risk-taking attitudes, anticipate greater risk-taking behavior, nor appear more likely to carry out the behavior. Hemophiliacs 15-19 years of age appear more likely to carry out the stated risk-taking behaviors when compared with younger (ll-14-year-old) hemophiliacs but not when compared with matched older.non-hemophiliacs. Risk-taking activities selected by hemophiliacs tend to be adaptive for the limitations imposed by their illness. The conclusion that hemophiliacs appear more likely to engage in risk-taking behavior as they get older, although the express no greater overall interest in risk-taking than do non-hemophilic adolescents, needs to be confirmed by behavioral observations as home care programs improve the activity potential of young hemophiliacs.
Asunto(s)
Hemofilia A/psicología , Asunción de Riesgos , Adolescente , Adulto , Factores de Edad , Actitud , Conducta , Niño , Humanos , Deportes , Encuestas y CuestionariosRESUMEN
The authors describe a 10-year experience with the two-team approach to complex operations for head and neck cancer. The general surgical team is responsible for the excision of the lesion and the plastic surgical team for the reconstruction. Twenty-seven patients have been treated in this way. A brief history, a general outline of overall management, the approach to oral, pharyngeal and extrinsic laryngeal lesions and the methods of reconstruction are described. The advantages and disadvantages of the method are presented. This approach has been found beneficial to the patients and satisfactory to the two surgical teams. In the opinion of the authors the advantages of this approach outweigh the disadvantages.