Little attention has been paid to the need for accountability instruments applicable across all health units in the public health system. One tool, the balanced scorecard was created for industry and has been successfully adapted for use in Ontario hospitals. It consists of 4 quadrants: financial performance, outcomes, customer satisfaction and organizational development. The aim of the present study was to determine if a modified nominal group technique could be used to reach consensus among public health unit staff and public health specialists in Ontario about the components of a balanced scorecard for public health units.
A modified nominal group technique consensus method was used with the public health unit staff in 6 Eastern Ontario health units (n=65) and public health specialists (n=18).
73.8% of the public health unit personnel from all six health units in the eastern Ontario region participated in the survey of potential indicators. A total of 74 indicators were identified in each of the 4 quadrants: program performance (n=44); financial performance (n=11); public perceptions (n=11); and organizational performance (n=8).
The modified nominal group technique was a successful method of incorporating the views of public health personnel and specialists in the development of a balanced scorecard for public health.
Using action-research methods and the principles of community development, a small working group initiated an organization-wide process to sensitize the Sunnybrook and Women's College hospital community to the relationship between violence and women's health. In this article, we explore the process by which the initiative was successfully introduced into the newly merged hospital. We describe critical factors for the initiative's success and offer some suggestions on how to maximize opportunities for organizational change.
To review the experience with an on-site medical tent for a mass gathering and to analyze patient records in a manner to more appropriately allocate resources and identify possible delays in definitive care.
The logistics of providing an on-site medical tent is reviewed, followed by a retrospective chart review of 126 patients over a two-year period. Prior to the chart review, an injury classification was developed that categorized patients based on the necessity of transport to hospital. Data were also analyzed for times of peak patient flow, types of injuries, and needless delays in definitive care.
An average of 63 patients (95% CI 44-77) were seen in the tent and 1.3 patients sought care per 10,000 spectators. Peak times were between 1600 and 2000 hours. The average number of patients each hour was 6.5 (95% CI 0-13). Severe, intermediate, and minor injuries accounted for 16%, 38%, and 46% of total injuries, respectively. Nine cases were found where the patients arrived and left the medical tent by ambulance. Four of these instances may have represented a needless delay in definitive care. The details of each of these cases are reviewed.
The results indicate that on-site medical coverage, with appropriate supports, is indeed safe. The frame-work provided with regard to setup and analysis of work-load will help others in the planning of medical care for similar mass gatherings.
E-health is increasingly valued for supporting: 1) access to quality health care services for all citizens; 2) information flow and exchange; 3) integrated health care services and 4) interprofessional collaboration. Nevertheless, several questions remain on the factors allowing an optimal integration of e-health in health care policies, organisations and practices. An evidence-based integrated strategy would maximise the efficacy and efficiency of e-health implementation. However, decisions regarding e-health applications are usually not evidence-based, which can lead to a sub-optimal use of these technologies. This study aims at understanding factors influencing the application of scientific knowledge for an optimal implementation of e-health in the health care system.
A three-year multi-method study is being conducted in the Province of Quebec (Canada). Decision-making at each decisional level (political, organisational and clinical) are analysed based on specific approaches. At the political level, critical incidents analysis is being used. This method will identify how decisions regarding the implementation of e-health could be influenced or not by scientific knowledge. Then, interviews with key-decision-makers will look at how knowledge was actually used to support their decisions, and what factors influenced its use. At the organisational level, e-health projects are being analysed as case studies in order to explore the use of scientific knowledge to support decision-making during the implementation of the technology. Interviews with promoters, managers and clinicians will be carried out in order to identify factors influencing the production and application of scientific knowledge. At the clinical level, questionnaires are being distributed to clinicians involved in e-health projects in order to analyse factors influencing knowledge application in their decision-making. Finally, a triangulation of the results will be done using mixed methodologies to allow a transversal analysis of the results at each of the decisional levels.
This study will identify factors influencing the use of scientific evidence and other types of knowledge by decision-makers involved in planning, financing, implementing and evaluating e-health projects.
These results will be highly relevant to inform decision-makers who wish to optimise the implementation of e-health in the Quebec health care system. This study is extremely relevant given the context of major transformations in the health care system where e-health becomes a must.
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To achieve the goal of adequately preparing graduating nurses for entry into practice, an undergraduate clinical nursing curriculum was enhanced by including an interventional radiology clinical rotation. The author describes the basics of this experience and the planning steps prior to implementation, including hospital approval, preceptor selection, and evaluation of the overall clinical experience.
Using a prospective design and a representative sample of 25-yr-old Norwegians, this study hypothesized that action planning and coping planning will add to the prediction of flossing at 4 wk of follow-up over and above the effect of intention and previous flossing. This study tested the validity of a proposed 3-factor structure of the measurement model of intention, action planning, and coping planning and for its invariance across gender. A survey was conducted in three Norwegian counties, and 1,509 out of 8,000 randomly selected individuals completed questionnaires assessing the constructs of action planning and coping planning related to daily flossing. A random subsample of 500 participants was followed up at 4 wk with a telephone interview to assess flossing. Confirmatory factor analysis (CFA) confirmed the proposed 3-factor model after respecification. Although the chi-square test was statistically significant [chi(2) = 58.501, degrees of freedom (d.f.) = 17), complementary fit indices were satisfactory [goodness-of-fit index (GFI) = 0.99, root mean squared error of approximation (RMSEA) = 0.04]. Multigroup CFA provided evidence of complete invariance of the measurement model across gender. After controlling for previous flossing, intention (beta = 0.08) and action planning (beta = 0.11) emerged as independent predictors of subsequent flossing, accounting for 2.3% of its variance. Factorial validity of intention, action planning and coping planning, and the validity of action planning in predicting flossing prospectively, was confirmed by the present study.
This study explored various factors and income sources that registered nurses believe are important in retirement planning.
In many countries worldwide, many registered nurses are approaching retirement age. This raises concerns related to the level of preparedness of retiring nurses.
A mail-out questionnaire was sent to 200 randomly selected nurses aged 45 and older. SPSS descriptors were used to outline the data. Multiple t-tests were conducted to test for significant differences between selected responses by staff nurses and a group of nurse managers, educators and researchers.
Of 124 respondents, 71% planned to retire by age 60. Only 24% had done a large amount of planning. The top four planning strategies identified were related to keeping healthy and active, both physically and mentally; a major financial planning strategy ranked fifth. Work pensions, a government pension and a personal savings plan were ranked as the top three retirement income sources. No significant differences were found between the staff nurse and manager groups on any of the items. IMPLICATIONS FOR NURSING MANAGERS/CONCLUSIONS: The results of this study suggest that managers' preparation for retirement is no different from that of staff nurses. All nurses may need to focus more on financial preparation, and begin the process early in their careers if they are to have a comfortable and healthy retirement. Nurse managers are in a position to advocate with senior management for early and comprehensive pre-retirement education for all nurses and to promote educational sessions among their staff. Managers may find the content of this paper helpful as they work with nurses to help them better prepare for retirement. This exploratory study adds to the limited amount of research available on the topic.
In the development process of establishing a Campus Health Resource Centre, a health needs assessment of 691 students was conducted at the University of Manitoba.
Students were surveyed by their peers to identify the health education needs of this population. The process of the health needs assessment is described and the results have formed the basis for a range of programs and services offered on campus.
Students showed interest in learning about stress management, cold and flu prevention, ergonomics and lifestyle (exercise, nutrition) issues.
Of note is low interest in topics generally thought to be important to students such as contraception, safer sex, and STD/AIDS prevention.
A multi-scaled model for biodiversity conservation in forests was introduced in Sweden 30 years ago, which makes it a pioneer example of an integrated ecosystem approach. Trees are set aside for biodiversity purposes at multiple scale levels varying from individual trees to areas of thousands of hectares, with landowner responsibility at the lowest level and with increasing state involvement at higher levels. Ecological theory supports the multi-scaled approach, and retention efforts at every harvest occasion stimulate landowners' interest in conservation. We argue that the model has large advantages but that in a future with intensified forestry and global warming, development based on more progressive thinking is necessary to maintain and increase biodiversity. Suggestions for the future include joint planning for several forest owners, consideration of cost-effectiveness, accepting opportunistic work models, adjusting retention levels to stand and landscape composition, introduction of temporary reserves, creation of "receiver habitats" for species escaping climate change, and protection of young forests.