Theoretical and perceived balance of power inside Spanish public hospitals

BACKGROUND: The hierarchical pyramid inside Spanish public hospitals was radically changed by the Health Reform Law promulgated in 1986. According to it, the manpower of the hospitals was divided into three divisions (Medical, Nursing, General Services/Administration), which from then on occupied the same level, only subject to the general manager. Ten years after the implementation of the law, the present study was designed in order to investigate if the legal changes had indeed produced a real change in the balance of power inside the hospitals, as perceived by the different workers within them. MATERIALS AND METHODS: A questionnaire was administered to 1,027 workers from four different public hospitals (two university-based and two district hospitals). The participants belonged to all divisions, and to all three operative levels (staff, supervisory and managerial) within them. The questionnaire inquired about the perceived power inside each division and hierarchical level, as well as about that of the other divisions and hierarchical levels. RESULTS: Every division attributed the least power to itself. The Nursing and the Administrative division attributed the highest power to the physicians, and these attributed the highest power to the General Services/Administrative division. All hierarchical levels (including the formal top of the pyramid) attributed significantly more power to the other than to them. CONCLUSIONS: More than ten years after the implementation of the new law, the majority of workers still perceive that the real power within the hospitals is held by the physicians (whereas these feel that it has shifted to the administrators). No division or hierarchical level believes it holds any significant degree of power, and this carries with it the danger of also not accepting any responsibility

Health promotion in primary care: How should we intervene? A qualitative study involving both physicians and patients

<p>Abstract</p> <p>Background</p> <p>The effects of tobacco, physical exercise, diet, and alcohol consumption on morbidity and mortality underline the importance of health promotion and prevention (HPP) at the primary health care (PHC) level. Likewise, the deficiencies when putting such policies into practice and assessing their effectiveness are also widely recognised. The objectives of this research were: a) to gain an in-depth understanding of general practitioners' (GPs) and patients' perceptions about HPP in PHC, and b) to define the areas that could be improved in future interventions.</p> <p>Methods</p> <p>Qualitative methodology focussed on the field of health services research. Information was generated on the basis of two GP-based and two patient-based discussion groups, all of which had previously participated in two interventions concerning healthy lifestyle promotion (tobacco and physical exercise). Transcripts and field notes were analysed on the basis of a sociological discourse-analysis model. The results were validated by triangulation between researchers.</p> <p>Results</p> <p>GPs and patients' discourses about HPP in PHC were different in priorities and contents. An overall explanatory framework was designed to gain a better understanding of the meaning of GP-patient interactions related to HPP, and to show the main trends that emerged from their discourses. GPs linked their perceptions of HPP to their working conditions and experience in health services. The dimensions in this case involved the orientation of interventions, the goal of actions, and the evaluation of results. For patients, habits were mainly related to ways of life particularly influenced by close contexts. Health conceptions, their role as individuals, and the orientation of their demands were the most important dimensions in patients' sphere.</p> <p>Conclusions</p> <p>HPP activities in PHC need to be understood and assessed in the context of their interaction with the conditioning trends in health services and patients' social micro-contexts. On the basis of the explanatory framework, three development lines are proposed: the incorporation of new methodological approaches according to the complexity of HPP in PHC; the openness of habit change policies beyond the medical services; and the effective commitments in the medium to long term by the health services themselves at the policy management level.</p

Cost-effectiveness and budget impact analyses of a colorectal cancer screening programme in a high adenoma prevalence scenario using MISCAN-Colon microsimulation model

This economic evaluation showed a screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer screening programme has been evaluated by budget impact analysis

El laboratorio de diagnóstico y su uso práctico dentro de un programa de mejora de la calidad de la leche

En este capítulo se resume nuestra experiencia en el diagnóstico bacteriológico de la mamitis ovina. A nuestro juicio, y ésa ha sido la pauta de comportamiento en estos años, un laboratorio de diagnóstico no sólo debe limitarse a la realización de una determinada demanda analítica; su implicación en el sector y en el seguimiento de diversos procesos puede contribuir a la toma de decisiones idóneas en los diversos programas encaminados a mejorar la sanidad y rentabilidad de las explotaciones ganaderas. Además, debe ser uno de los puntos de referencia para la adecuación de los programas preventivos con vistas a obtener un producto final de calidad y con garantías de seguridad para los consumidores. A nuestro juicio, el uso del laboratorio no debería restringirse a los brotes clínicos agudos, o situaciones problemáticas en las que, aunque se aporte un diagnóstico fiable, en el mejor de los casos se detendrá la progresión de la enfermedad y las pérdidas económicas ocasionadas. Por el contrario, un uso regular a modo de vigilancia, con intencionalidad preventiva, es el mejor camino para rentabilizar el coste de los análisis y utilizar la información generada regularmente para adecuar determinadas decisiones del manejo de la explotación. Se recomienda asimismo el análisis bacteriológico en brotes agudos de mamitis clínicas, así como de las ovejas de nueva incorporación, con atención especial a Streptococcus agalactiae, Staphylococcus aureus y Mycoplasma agalactiae. El muestreo bacteriológico debe acomodarse a la problemática observada; sin embargo, en condiciones habituales debe incluir ovejas con mamitis subclínicas, clínicas, ovejas primíparas y la leche del tanque. Nosotros hemos sistematizado el número de muestras lácteas individuales necesarias para el diagnóstico de la problemática de mamitis, consistente en 9 muestras individuales y la leche del tanque (Método 9+1). Ante una selección adecuada de muestras, con una información mínima asociada y un historial clínico riguroso, el laboratorio de diagnóstico puede aportar un valioso asesoramiento al veterinario responsable de un programa de mejora de la calidad de la leche