Span of Control and IHS Staffing Patterns

The objective of this study was to research the subject of span of control as it applies to the management of work, to assess factors impacting supervisory ratios, to assess Indian Health Service (IHS) staffing data to determine supervisory ratios, to identify relevant industry span of control supervisory ratios, and to make findings and recommendations. The purpose of this study was to assess whether or not the IHS\\u27s span of control is consistent with industry standards.The analysis required research on managerial span of control standards and ratios from variety of sources, including health care organization literature, Office of Personnel Management (OPM) documentary material, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards and manuals, and health care industry staffing data. The analysis also involved obtaining, processing, tabulating, and summarizing IHS agency-wide staffing data by occupational series, location, and function to determine span of control supervisory ratios, and similar data from the American Hospital Association (AHA) on staffing patterns.Corporate responsibilities are organized functionally, but direct health care operations are performed on a team basis. In the field of health care delivery, the literature does not specify recommended span of control. The statutory mandates do not speak to span of control. Rather, they support a mission, which is critical and complex. There was no data found on supervisory ratios for the private sector. The IHS staffing patterns at hospitals and health centers are consistent with the unique IHS mission.The authors recommend conducting a management review/case study to obtain a realistic view of the supervisory ratios for IHS hospitals and health centers. Case studies of the total staffing profile, (including non-IHS employees), the organizational structure, team responsibilities, and span of control at three IHS hospitals would be a useful starting point. Also, a roundtable conference on organization issues for health care delivery facilities may prove beneficial. This study suggests the need for an IHS health facility profile database. The database may include information on locations, organizations, FTEs, budget, program descriptions, workload measures, contracting/compacting data, CHS/fiscal intermediary data, etc., to support IHS Headquarters management and analysis needs

IHS Organizational Model with Block Grant Type Functions

Purpose The objective of this study was to research organizational models for the management of block grants, to identify the functions and responsibilities of the current Indian Health Service (IHS) organization, to estimate the staffing and overhead costs for IHS, and to determine a model for IHS in the event that all direct health care services are delivered by tribal organizations instead of IHS. The purpose of the study was to identify an organizational structure, staffing, and cost estimate for an IHS organization which is focused on the responsibilities of managing tribal self-governance and Indian Self-Determination Act funds. Methods The analysis required research on organizational structure, managerial responsibilities, and operational issues for a variety of Federal agencies, including Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health. The analysis also involved obtaining, processing, tabulating, and summarizing IHS agency-wide budget and staffing, personnel costs, overhead costs, and other factors which impact on the budget needs of IHS under a structure which is block grant management oriented. Results The IHS Headquarters organization could be restructured to fully carry out the self-governance program management and support mission in Rockville, Maryland. The IHS Area Offices could be reorganized to carry out technical assistance and data collection and evaluation, as well as direct liaison with the Tribes. Conclusion This analysis reviews the potential changes within IHS, if all health care service delivery is turned over to the tribes

Self-healing Multi-Cloud Application Modelling

Cloud computing market forecasts and technology trends confirm that Cloud is an IT disrupting phenomena and that the number of companies with multi-cloud strategy is continuously growing. Cost optimization and increased competitiveness of companies that exploit multi-cloud will only be possible when they are able to leverage multiple cloud offerings, while mastering both the complexity of multiple cloud provider management and the protection against the higher exposure to attacks that multi-cloud brings. This paper presents the MUSA Security modelling language for multi-cloud applications which is based on the Cloud Application Modelling and Execution Language (CAMEL) to overcome the lack of expressiveness of state-of-the-art modelling languages towards easing: a) the automation of distributed deployment, b) the computation of composite Service Level Agreements (SLAs) that include security and privacy aspects, and c) the risk analysis and service match-making taking into account not only functionality and business aspects of the cloud services, but also security aspects. The paper includes the description of the MUSA Modeller as the Web tool supporting the modelling with the MUSA modelling language. The paper introduces also the MUSA SecDevOps framework in which the MUSA Modeller is integrated and with which the MUSA Modeller will be validated.The MUSA project leading to this paper has received funding from the European Union’s Horizon 2020 research and innovation pro- gramme under grant agreement No 644429

Perinatal HIV transmission and the cost-effectiveness of screening at 14 weeks gestation, at the onset of labour and the rapid testing of infants

<p>Abstract</p> <p>Background</p> <p>Preventing HIV transmission is a worldwide public health issue. Vertical transmission of HIV from a mother can be prevented with diagnosis and treatment, but screening incurs cost. The U.S. Virgin Islands follows the mainland policy on antenatal screening for HIV even though HIV prevalence is higher and rates of antenatal care are lower. This leads to many cases of vertically transmitted HIV. A better policy is required for the U.S. Virgin Islands.</p> <p>Methods</p> <p>The objective of this research was to estimate the cost-effectiveness of relevant HIV screening strategies for the antenatal population in the U.S. Virgin Islands. An economic model was used to evaluate the incremental costs and incremental health benefits of nine different combinations of perinatal HIV screening strategies as compared to existing practice from a societal perspective. Three opportunities for screening were considered in isolation and in combination: by 14 weeks gestation, at the onset of labor, or of the infant after birth. The main outcome measure was the cost per life year gained (LYG).</p> <p>Results</p> <p>Results indicate that all strategies would produce benefits and save costs. Universal screening by 14 weeks gestation and screening the infant after birth is the recommended strategy, with cost savings of $1,122,787 and health benefits of 310 LYG. Limitations include the limited research on the variations in screening acceptance of screening based on specimen sample, race and economic status. The benefits of screening after 14 weeks gestation but before the onset of labor were also not addressed.</p> <p>Conclusion</p> <p>This study highlights the benefits of offering screening at different opportunities and repeat screening and raises the question of generalizing these results to other countries with similar characteristics.</p