The research group, the conference programme and academic training in safety promotion - a report of the activities at Karolinska Institutet, Sweden

The research group was established in 1967 at Lund University and moved to Karolinska Institutet in 1980. Work began with epidemiological studies of all injuries in the local community in support of various experimental local interventions. An important element was the creation of 'surveillance systems' in healthcare. The work resulted in the establishment of a WHO Collaborating Centre and an international safety-building programme called 'Safe Communities'. In parallel, training at both master's and doctoral level and the building of a conference programme were embarked upon. The research group consists of three sections. Specific efforts are being made by some countries to address their own injury problems.     

Essential health care: affordable for all?

Access to affordable health care has become a national crisis. The uninsured have many faces and many reasons for being uninsured. The nation cannot afford to sustain this broken system; not in terms of resources, nor in terms of the deteriorating health of the public. Universal coverage could offer a promising opportunity to begin to ameliorate the unsustainable use of expensive illness care now substituting for effective low-cost prevention and early detection. A proposal for essential health care coverage, a balance between cost and choice to maximize use of beneficial care, is presented.     

In search of a big enough stick to tame the wild operating room inventory beast

This article discusses the many aspects of a prime vendor relationship with a medical-surgical distributor. It outlines features or value-added services that should be included when a hospital embarks on a new prime vendor relationship or tries to improve an existing one.     

Nursing case management: affecting quality and cost

North Mississippi Health Services' nursing case management program has been deemed a success by all parties involved, especially the patients. High-risk patients with specific chronic health problems receive an enhanced level of care and experience significant reductions in cost, length of stay, and repeat hospitalizations. Quality of life for many of these patients is also improved. These outcomes are made possible by assigning a registered nurse to case manage or coordinate care for these patients.     

Mortality risk assessment in the elderly: the utility of delayed word recall

Cognitive impairment is an important predictor of mortality in the elderly. An extended delayed word recall (DWR) is one of the most sensitive tests for cognitive impairment. A mortality study was performed on a population of long-term care insurance applicants aged 70 and older who were underwritten during the years 1995-2003 and who had cognitive testing by DWR. Within this relatively short period of time, individuals with DWR score of 0-5 compared to those with DWR score of 6-10 had a markedly worse mortality outcome overall and also when analyzed by gender, underwriting age, underwriting year or smoking status.     

The people who make organizations go--or stop

Managers invariably use their personal contacts when they need to, say, meet an impossible deadline or learn the truth about a new boss. Increasingly, it's through these informal networks--not just through traditional organizational hierarchies--that information is found and work gets done. But to many senior executives, informal networks are unobservable and ungovernable--and, therefore, not amenable to the tools of management. As a result, executives tend to work around informal networks or, worse, try to ignore them. When they do acknowledge the networks' existence, executives fall back on intuition--scarcely a dependable tool--to guide them in nurturing this social capital. It doesn't have to be that way. It is entirely possible to develop and manage informal networks systematically, say management experts Cross and Prusak. Specifically, senior executives need to focus their attention on four key role-players in informal networks: Central connectors link most employees in an informal network with one another; they provide the critical information or expertise that the entire network draws on to get work done. Boundary spanners connect an informal network with other parts of the company or with similar networks in other organizations. Information brokers link different subgroups in an informal network; if they didn't, the network would splinter into smaller, less effective segments. And finally, there are peripheral specialists, who anyone in an informal network can turn to for specialized expertise but who work apart from most people in the network. The authors describe the four roles in detail, discuss the use of a well-established tool called social network analysis for determining who these role-players are in the network, and suggest ways that executives can transform ineffective informal networks into productive ones.