A health maintenance organization design for long term care under medicaid

The rapid increase in public expenditures for long term care under Medicaid is discussed. The major cause of this increase is identified as the high and often excessive utilization of nursing home care. Health maintenance organizations (HMOs) are considered in terms of their ability to reduce health care costs by curbing unnecessary hospitalization. The HMO structure is extended to long term care, where it is argued that unnecessary nursing home care can be reduced. A health maintenance organization targeted to the Medicaid long term care population is proposed and a detail flow analysis of the HMO is presented.     

Transforming your manufacturing organization into a learning organization.

Many experts believe the only sustainable advantage an organization will have in the future is its ability to learn faster than its competitors. This competitive advantage can be achieved by transforming the organization into a learning organization. This article describes the basic elements of a learning organization and how to transform an organization to focus on learning. The article also describes methods for evaluating the training and learning that occurs within the organization to ensure that training dollars are wisely spent. Finally, the article describes what individuals can do to focus on their own learning and personal development within an organization.     

Microworlds and Simuworlds: Practice fields for the learning organization

Management is one of the few professions, the authors note, in which members have no formal “rehearsal space” for honing their skills. In response to this need, organizations such as The Center for Creative Leadership, MIT's Learning Center, and The Stern School of Business at New York University have created a brave new world of management simulations—“practice fields” for the learning organization. Some of these new games (“simuworlds”) use computer programs to replicate an entire industry and give participants an opportunity to play out one company's strategy in that setting. Other simulations (“microworlds”) engage participants in complex behavioral role playing, based on scenarios that typically develop within a company. Still other simulations combine both approaches. The authors take their point of departure from Peter Senge's definition of the “learning barriers” that develop in any organization: solving fragmented “problems” rather than dealing with systemic issues; overemphasis on competition at the expense of cooperation; and a failure to innovate until forced to do so. The new simulations, the authors argue, are particularly useful in helping managers learn how to overcome these barriers.     

Disseminating knowledge to build a learning organization

In recent years the learning organization has become popular in the management literature but the extent to which staff typically obtain access to the information they need for enhanced learning is not well understood. This paper examines the access to information experienced by staff within a New Zealand company in terms of the topics on which information is received and the sources from which information comes. The results show significant divisions within the company on status grounds for information that is currently received. Nevertheless, no such divisions were found for the information that is sought. Limitations appeared more obviously with regard to formal information sources (for which the company is responsible) than for the informal sources (which the individual finds it easier to access). Implications for companies aspiring to strengthen their capacity to learn are briefly discussed.     

推进学习型组织健康发展——学习型组织在中国实践的挑战与对策

一、学习型组织在中国:行进在繁荣与泡沫的边缘 虽然对组织学习的研究最早可以追溯至上个世纪六七十年代,但真正引起人们对该领域的广泛关注,并大量研究与实践的是1 990年.时年,原麻省理工大学斯隆管理学院教授彼得·圣吉的巨著<第五项修炼--学习型组织的艺术与实务>一书出版.在书中,圣吉整合了系统动力学、社会心理学等社会科学的研究成果,提出了创建学习型组织的"五项修练"的核心思想.该书迅速成为全球商业类畅销书,极大地推动了学习型组织的发展.     

加强学习型党组织建设的探索与实践

文章从分析科技型企业加强学习型党组织建设的主要背景入手,分析了长沙矿冶研究院建设学习型党组织的现实意义,研究了建设成果和主要做法,探讨了科技型企业建设学习型党组织的主要对策。     

Total quality in health care

Quality is at the top of American consumers' demand list, and consequently American manufacturing companies have been forced to assign priority to the development of high-quality products. To improve the quality of what they offer, many manufacturers use the management philosophy known as total quality management (TQM), and now the service sector is following in their footsteps. The health care industry is a good example of a service industry that can benefit greatly from TQM, and it is the purpose of this article to show how a health care provider can implement TQM and evaluate its effects.     

Environmental laws in health care

Federal and state regulations regarding the management and disposal of medical waste are currently quite extensive and will only become more comprehensive in the future. The public's heightened awareness and concerns over infectious diseases and discoveries of medical waste on beaches in New Jersey, Alabama, and other states, as well as medical waste being found in open trash bins and at public landfills, has brought to the public's attention the need for governmental intervention into this growing area of concern. Because regulations originating from the local, state, and federal levels have the potential to significantly affect hospitals, it is important that a specific person or department within the organization have a clearly designated responsibility to stay informed and follow up on these regulations. The designated person or department must work closely with the hospital's attorney to make sure that he or she stays current on environmental laws and keeps the institution adequately advised of its legal responsibilities.     

Requirements planning systems in the health care environment

An important problem confronting health care administration is cost containment in hospitals. Much of the current high costs can be traced directly to outdated procedures in materials management leading to waste, excessive inventory and unnecessary obsolescence of expensive short shelf life items. In this paper, we illustrate how a modern requirements planning system for surgical supplies was developed for a private hospital in Houston and used to effectively hold inventory levels to the minimum required to support a detailed schedule of surgical procedures. We also discuss some specific problems involved in the transfer of manufacturing technology to the hospital setting.     

Trends in multiculturalism in health care

Materiel managers are faced with a shrinking world and changing work environment. The needs and expectations of the customer have shifted because of the increasing number of multicultural groups. These groups will continue to assert their right to culturally sensitive care. Materiel managers also need to learn to support and enhance the skills of a multicultural work force. One important tool for change will be technology. However, technology that brings the world closer together also creates new challenges for managers, who will have to deal with multicultural colleagues, buyers, sellers, and manufacturers of goods and services.     

Efficiency and productivity change in Ukrainian health care

The study analyses technical efficiency and efficiency change of 193 community hospitals and polyclinics across Ukraine, for the years 1997–2001. These facilities are a subset of the medical institutions in rural Ukraine; they are identical w.r.t. their function in the health system and share the same departmental structure. The data comprise the number of beds in the hospitals, the number of staff employed in the hospitals as well as the polyclinics connected to the hospitals, the number of inpatient and outpatient admissions as well as the number of surgical procedures, lab tests, X-rays performed and the number of deaths and deaths after surgery. Because of the known sensitivity of traditional nonparametric frontier estimators to outlier observations, we employ an order-m estimator, a robust technique, to assess the efficiency of these health care providers as well as changes of their productivity time. The efficiency scores are calculated with an output-oriented model; they are close to unity for hospitals whereas polyclinics seem somewhat less efficient. The Malmquist-indices averaged over all observations are close to unity indicating that productivity does not change over during our observation period. But, depending on the period and the region, substantial deviations from unity can be observed.

SIPP and health care issues.

There are three major areas in health care policy which can be addressed by the data elements in the Survey of Income and Program Participation (SIPP): (1) health insurance coverage and the stability of insurance over time; (2) health disability and its relationship to socioeconomic variables, including unemployment, over time; and (3) health care utilization. The survey does not, however, include information on health care expenditures or on details of visits to providers.