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Executive
Summary
Ethical
Dilemmas in Home Care Case Management
Elaine Gallagher, Ph.D., School of Nursing, University of Victoria; Denise
Alcock, Ph.D., faculty of health sciences, University of Ottawa; Elizabeth
Diem, Ph.D., faculty of health sciences, University of Ottawa; Douglas
Angus, M.A., faculty of administration, University of Ottawa; and Jennifer
Medves, Ph.D., faculty of health sciences, University of Ottawa
The role
of case manager is fraught with challenges in a healthcare environment
characterized by rapid aging of the population, a move against institutionalization
of seniors, and the need to contain healthcare costs. This study examined
experiences of 89 case managers through focus groups in five urban and
five rural regions of Canada to identify ethical dilemmas and issues encountered
in the role. Overall, the case managers expressed frustration for the
lack of support for their work as evidenced by inadequate resources and
few agency policies. The analysis of the focus group data revealed four
main themes in relation to ethical concerns and dilemmas: (1) issues related
to equity, (2) beneficence, (3) non-maleficence, and (4) autonomy and
power imbalances. The situation facing these workers is grave and steps
must be taken to provide them with ongoing training, support, and resources
to continue in this vital role. System changes that would reduce some
of the ethical conflicts experienced by case managers include funding
for long-term care to keep pace with growing demands, better management
of client waitlists to ensure that the most needy are given the highest
priority, more supportive housing options that provide for some on-site
coordination of services, better opportunities for health promotion, and
better interdisciplinary teamwork so that case managers are not left making
decisions in the absence of other key service providers.
Executive
Summary
Rekindling
the Flame: Routine Practices That Promote Hospital Community Leadership
Peter Weil, Ph.D., FACHE, vice president of research and development,
American College of Healthcare Executives, Chicago, and Rita Harmata,
Ph.D., CHE, director, Trustee and Community Leadership, American Hospital
Association, Chicago
Because of
the need to focus on their financial survival, hospitals and health systems
are not the popular community-oriented institutions they once were-too
many have set aside their mission to promote and protect the health of
their communities. . By conducting on-site interviews with CEOs, other
executives, board members, and community partners in seven hospitals across
the nation, we discovered 25 management and governance practices used
by hospitals that excel in relating to their communities. We have grouped
these practices for promoting community health into six functions: (1)
identifying community needs; (2) setting goals; (3) allocating financial
and human resources; (4) educating leaders, staff, and community members;
(5) measuring outcomes; and (6) sustaining the mission. Specific examples
are given that describe what we learned. Ultimately, we hope to engender
a dialog about other management and governance practices that have proven
successful in promoting hospitals' involvement in community health.
Executive
Summary
Racial/Ethnic
Diversity Management and Cultural Competency: The Case of Pennsylvania
Hospitals, Robert Weech-Maldonado, Ph.D., assistant professor, department
of health policy and administration, The Pennsylvania State University,
University Park; Janice L. Dreachslin, Ph.D., associate professor of health
policy and administration, Penn State Great Valley School of Graduate
Professional Studies, Malvern; Kathryn H. Dansky, Ph.D., associate professor,
department of health policy and administration, The Pennsylvania State
University, University Park; Gita De Souza, Ph.D., assistant professor
of business administration, Penn State-Delaware County Campus, Media;
and Maria Gatto, health insurance specialist, Centers for Medicare and
Medicaid Services, Chicago
Major demographic
trends are changing the face of America's labor pool, and healthcare managers
increasingly face a scarcer and more diverse workforce. As a result, healthcare
organizations (HCOs) must develop policies and practices aimed at recruiting,
retaining, and managing a diverse workforce and must meet the demands
of a more diverse patient population by providing culturally appropriate
care and improving access to care for racial/ethnic minorities. Ultimately,
the goal of managing diversity is to enhance workforce and customer satisfaction,
to improve communication among members of the workforce, and to further
improve organizational performance. Research on diversity management practices
in healthcare organizations (HCOs) is scarce, providing few guidelines
for practitioners. This study attempted to close that gap. Results show
that hospitals in Pennsylvania have been relatively inactive with employing
diversity management practices, and equal employment requirements are
the main driver of diversity management policy. The number and scope of
diversity management practices used were not influenced by organizational
or market characteristics. The results suggest that hospitals need to
adopt diversity management practices for their workforces and need to
pay particular attention to marketing and service planning activities
that meet the needs of a diverse patient population.
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