RESUMEN
Employee involvement has increasingly been recognized as important for improving both quality and cost effectiveness. Given the especially crucial role played by employees in the health-care field, and the relatively high level of education and sophistication that characterizes this group, it is also recognized that initiating and sustaining meaningful employee involvement programs in a health-care setting represent unique challenges and opportunities. This article presents the operational evolution of a successful employee involvement program in a large, diversified academic medical center. The developed program includes quality-improving and revenue-enhancing suggestions as well as cost-containment ideas. Specific operational issues and program changes are examined within the context of the total quality process at the University of Michigan Medical Center. Finally, this article identifies three main types of incentives that can maximize the results obtained by employee involvement programs in health-care settings.
Asunto(s)
Centros Médicos Académicos/organización & administración , Personal de Hospital , Desarrollo de Programa/métodos , Garantía de la Calidad de Atención de Salud/organización & administración , Distinciones y Premios , Control de Costos , Planes para Motivación del Personal , Humanos , Michigan , Innovación OrganizacionalRESUMEN
A series of 148 patients who underwent reduction mammaplasty utilizing the superomedial pedicle technique is presented. Resections as large as 4100 gm per breast with nipple-areola transpositions up to 30 cm were done with reliable nipple-areola survival, including preservation of sensation. The superior pedicle technique of breast reduction is recognized by many as technically easier and capable of producing a longer-lasting aesthetic effect. Classically, however, it has been limited to smaller resections. By incorporating the medial quadrant in the superior pedicle, more aggressive reductions can be safely undertaken with the same excellent results. Details of the procedure, the anatomic basis for its success, and complications are discussed.
Asunto(s)
Mama/cirugía , Cirugía Plástica/métodos , Adolescente , Adulto , Anciano , Mama/patología , Femenino , Estudios de Seguimiento , Humanos , Hipertrofia/cirugía , Persona de Mediana Edad , Pezones/cirugía , Colgajos QuirúrgicosRESUMEN
We present a technique for the treatment of prominent ears using a diamond burr to produce a very natural and stable antihelical fold. Our experience in the treatment of over 43 ears over a ten-year period has been very satisfactory for both patient and surgeon. This procedure overcomes many of the shortcomings of more traditional techniques of otoplasty, including suture pull-through, widened antihelical fold, and an unpredictable, unstable result.