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This paper provides a brief overview of the supply of healthcare professionals and some of the factors impacting supply. The demand for healthcare professionals and some of the factors impacting demand are then addressed. Finally, a brief overview of the health reform law recently passed, the Patient Protection and Affordable Care Act, is provided as it pertains to the supply of and demand for health professionals.

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The healthy communities movement can provide insight into population health efforts in the United States, particularly in the context of recent health care reform. The movement has evolved from multisector partnerships that focused on improving the health, well-being, and quality of life for people and the social determinants of health to partnerships that focus more on chronic disease prevention, health equity, and environmental change. Evaluating the effects of community programs on population health has been challenging for a number of reasons. More metrics need to be developed for population health that will address inequities and focus policies on long-term health effects.

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OBJECTIVE: To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of safety climate, and to clarify the steps and implementation of rigorous WalkRounds. DATA SOURCES/STUDY SETTING: Primary outcome variables were baseline and post WalkRounds safety climate scores from the Safety Attitudes Questionnaire (SAQ). Secondary outcomes were safety issues elicited through WalkRounds. Study period was August 2002 to April 2005; seven hospitals in Massachusetts agreed to participate; and the project was implemented in all patient care areas. STUDY DESIGN: Prospective study of the impact of rigorously applied WalkRounds on frontline caregivers assessments of safety climate in their patient care area. WalkRounds were conducted weekly and according to the seven-step WalkRounds Guide. The SAQ was administered at baseline and approximately 18 months post-WalkRounds implementation to all caregivers in patient care areas. RESULTS: Two of seven hospitals complied with the rigorous WalkRounds approach; hospital A was an academic teaching center and hospital B a community teaching hospital. Of 21 patient care areas, SAQ surveys were received from 62 percent of respondents at baseline and 60 percent post WalkRounds. At baseline, 10 of 21 care areas (48 percent) had safety climate scores below 60 percent, whereas post-WalkRounds three care areas (14 percent) had safety climate scores below 60 percent without improving by 10 points or more. Safety climate scale scores in hospital A were 62 percent at baseline and 77 percent post-WalkRounds (t=2.67, p=.03), and in hospital B were 46 percent at baseline and 56 percent post WalkRounds (t=2.06, p=.06). Main safety issues by category were equipment/facility (A [26 percent] and B [33 percent]) and communication (A [24 percent] and B [18 percent]). CONCLUSIONS: WalkRounds implementation requires significant organizational will; sustainability requires outstanding project management and leadership engagement. In the patient care areas that rigorously implemented WalkRounds, frontline caregiver assessments of patient safety increased. SAQ results such as safety climate scores facilitate the triage of quality improvement efforts, and provide consensus assessments of frontline caregivers that identify themes for improvement.

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Economic stability and viability are an important part of doing business, but it's time health care leaders worried more about compassion and effective care.

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Collaboration among a community's institutions and its residents can help increase the use of appropriate screening, preventive, and primary care services. To improve the health of the community, institutions must reach out to their colleagues and other stakeholders. They must not only deal with the structure of the healthcare delivery system but also be responsive to the characteristics of the local population groups they are trying to serve. Over the last several years, a group of 25 community-based partnerships across the country have used a multifaceted model to guide their work in making their communities healthier. Through a wide variety of initiatives tailored to local needs, they have not only improved people's health but also provided a series of benefits to the partnering organizations and the community as a whole.

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Evaluations of multisite community-based projects are notoriously difficult to conceptualize and conduct. Projects may share an overarching vision but operate in varying contexts and pursue different initiatives. One tool that can assist evaluators facing these challenges is to develop a "theory of action" (TOA) that identifies critical assumptions regarding how a program expects to achieve its goals. Community Care Network (CCN) evaluators used the TOA to refine research questions, define key variables, relate questions to each other, and identify when we might realistically expect to observe answers. In this article, the authors present their national-level CCN TOA. They also worked with sites to help them "surface" their local TOA; the article analyzes the results to determine the content, clarity, extent of evidence base, and strategic orientation of theories articulated by different sites.

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BACKGROUND: Hospital medication practices should be assessed, awareness of the characteristics of a safe medication system heightened, and baseline data to identify national priorities established. DESIGN: A cross-sectional survey of U.S. hospitals (N = 6,180) was conducted in May 2000. The survey instrument contained 194 self-assessment items organized into 20 core characteristics and 10 larger domains. Hospitals were asked to voluntarily submit their confidential assessment data to the Institute for Safe Medication Practices (ISMP) for aggregate analysis. METHOD: A weighting structure was applied to the individual items and used to calculate core characteristic scores, domain scores, and overall self-assessment scores. These scores were then compared to identify areas most in need of improvement. RESULTS: The 1,435 participating hospitals scored highest in domains related to drug storage and distribution; environmental factors; infusion pumps; and medication labeling, packaging, and nomenclature issues. These hospitals scored lowest in domains related to accessible patient information, communication of medication orders, patient education, and quality processes such as double-check systems and organizational culture. CONCLUSIONS: Enormous opportunities exist to improve medication safety, especially in domains related to culture, information management, and communication.

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