THE WELL-MANAGED HEALTHCARE ORGANIZATION

The Well-Managed Healthcare Organization

The Well-Managed Healthcare Organization

Introduction

A “physician practice” is a health perform comprised of two or more physicians coordinated to supply persevering care services (regardless of its lawful pattern or ownership). For demonstration, a “physician practice” may be a assembly of physicians that perform simultaneously but manage not rendezvous all of the obligations of §411.352 for “group practices” for reasons of persuading the obligations of the doctor services and in-office ancillary services exceptions. ering care services to its inpatients and outpatients.

Organizational Design

Organizational design is a formal, guided process for integrating the people, information, and technology of an organization, and serves as a key structural element that allows corporations to maximize value by matching their corporate design to overall strategy. From a strategy perspective, organizational design is an untapped variable that needs to be addressed in the context of organizational strategy and change. As attention to clinical quality becomes more of a priority, it will be essential for health-care institutions to evolve organizational and management structures that support the design and implementation of quality-improvement initiatives and create mechanisms for accountability for quality of care. Moreover, organizations in most industries are in constant evolution, so organizational design should be considered a variable and evolving tool for improving organizational performance.

As hospital-based care became the dominant system of health-care delivery in the 20th century, most hospitals adopted a functional model based on discipline-based specialization.Each functional area (i.e. various clinical departments, nursing, laboratory services) has a manager that reports to higher management levels and eventually to the hospital's chief executive officer. Although this centralized design has allowed for efficiency based on scales of economy, it limits integration across functions and the ability to develop innovative, creative quality-improvement processes and solutions at the level of the service line.

For example, most total quality management projects originate and are implemented at the level of hospital management teams through high-end administrative and support services. However, clinical care is administered at a service-line level by clinicians and teams of complementary health-care professionals (i.e. nurses, therapists, pharmacists, etc). The conflict between central control and local autonomy and accountability is a key issue to resolve for most organizations.

Achieving Evidence-Based Medicine

The idea of evidence based practice for nursing has grown out of the evidence based medicine movement. Evidence based practice can be thought of as "integrating individual clinical expertise with the best available external clinical evidence from systematic research."(Sackett, 1996) At its best, evidence based practice should give the clinician the tools to help her enhance clinical effectiveness and affect the delivery of healthcare based on the integration of research, clinical guidelines and outcomes assessments into clinical practice. (DeBourgh, 2001) On a practical level this Web site for evidence based practice seeks to give an overview of the topic, with lists of helpful articles, and covers:

forming a good clinical question

finding the evidence using effective search techniques

some resources for evidence based practice including databases, e-journals, e-textbooks and other Internet ...