Embracing Accountability: Physician Leadership, Public Reporting, and Teamwork in the Wisconsin Collaborative for Healthcare Quality

Based on interviews, presents a case study of how a "bottom-up" physician-led group of healthcare providers realized voluntary public reporting of comparative performance information as a quality improvement tool. Shares requirements and lessons learned

Pathways to “Evidence-Informed” Policy and Practice: A Framework for Action

Bowen and Zwi propose a new framework that can help researchers and policy makers to navigate the use of evidence

General practitioners' conceptions about treatment of depression and factors that may influence their practice in this area. A postal survey

BACKGROUND: The way GPs work does not appear to be adapted to the needs of depressive patients. Therefore we wanted to examine Swedish GPs' conceptions of depressive disorders and their treatment and GPs' ideas of factors that may influence their manner of work with depressive patients. METHODS: A postal questionnaire to a stratified sample of 617 Swedish GPs. RESULTS: Most respondents assumed antidepressive drugs effective and did not assume that psychotherapy can replace drugs in depression treatment though many of them looked at psychotherapy as an essential complement. Nearly all respondents thought that clinical experiences had great importance in decision situations, but patients' own preferences and official clinical guidelines were also regarded as essential. As influences on their work, almost all surveyed GPs regarded experiences from general practice very important, and a majority also emphasised experiences from private life. Courses arranged by pharmaceutical companies were seen as essential sources of knowledge. A majority thought that psychiatrists did not provide sufficient help, while most respondents perceived they were well backed up by colleagues. CONCLUSION: GPs tend to emphasize experiences, both from clinical work and private life, and overlook influences of collegial dealings and ongoing CME as well as the effects of the pharmaceutical companies' marketing activities. Many GPs appear to need more evidence based knowledge about depressive disorders. Interventions to improve depression management have to be supporting and interactive, and should be combined with organisational reforms to improve co-operation with psychiatrists

The continuity of moral reform: Community mental health centers

Contemporary involvement of citizens in the formation of mental health policies continues a long history of influential lay advocates achieving desired reforms. The Community Mental Health Centers Program arose from, and also recognized, the citizens' movement for community care. This legislation mandated and encouraged citizen membership on the governing boards of local centers. The influence of these citizen bodies is seen in the diversity and continuing evolution of the local centers structurally, in orientation and in services provided. Three examples from original field research are provided to illustrate.

Medical technology and professional dominance theory

The expansion of medical technology in hospitals is commonly asserted to be a result of the preferences of medical doctors translated into organizational policies as a result of professional dominance in health care organizations. This paper examines the theoretical and empirical bases for hypotheses of professional dominance and the utility of these hypotheses in explaining hospital decisions to adopt new medical technologies. The analysis, which is based on 5 years of data collection including 378 personal interviews at 25 U.S. hospitals, indicates that appropriate application of the concept requires specification of the type of physician exercising influence and of the hospital decision systems within which it is exercised. Specification is needed because neither physicians nor hospitals are unitary categories when considered in relation to technology adoptions. In this paper, four categories of physicians are identified: community generalists, community specialists, referral specialists and hospital-based specialists. Members of these categories exhibit different skills and interests, different relationships to hospitalstechnologies, and differential access to the resources of organization influence including two unrelated to professional dominance. To understand the exercise of physician influence, it is further useful to differentiate three decision systems which review and pass judgement on different types of hospital technologies. They are: the medical-individualistic, the fiscal-managerial and the strategic-institutional. The three decision systems make decisions in accord with different values and goals and display different decision structures and dynamics. Ironically, the physicians who most clearly possess the resources of influence associated with professional dominance are centrally involved in only one of the three systems. They play only minor roles in the two which make the most far reaching and costly technological decisions.

Cities and sickness : health care in urban America

303 hal.; 21c