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Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator’s guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change.

As the vast repository of data about millions of patients grows, the analysis of this information is changing the provider-patient relationship and influencing the continuum of care for broad swaths of the population. At the same time, while population health management moves from a volume-based model to a value-based one and additional patients seek care due to healthcare reform, hospitals and healthcare networks are evaluating their business models and searching for new revenue streams. Utilizing geographical information systems to model and analyze large amounts of data is helping organizations better understand the characteristics of their patient population, demographic and socioeconomic trends, and shifts in the utilization of healthcare. In turn, organizations can more effectively conduct service line planning, strategic business plans, market growth strategies, and human resource planning. Healthcare organizations that use GIS modeling can set themselves apart by making more informed and objective business strategy decisions.

A small, rural community takes the effort to make the transition from a skilled nursing facility to an assisted living model of care delivery. These changes are needed because of the cost and access of services available in this setting. The system of care delivery being considered is based on the model called Aging in Place (AIP).

The collaborative process of team-based planning draws upon the strengths of a team and develops the skills that healthcare providers need to build consensus during this time of significant change. This article describes three examples of team-based planning and shows how applying an integrated set of tools can help formulate plans and create new options to meet the challenges facing today's healthcare organizations.

This paper describes briefly the process of early planning and establishment of community-based medical schools in developing world with highlights of the key issues and mile-stones. The author works for WHO (World Health Organization) Office in University of Gezira, Sudan. After outlining some basic concerns and provisos for the Dean and suggested strategies for setting the stage (preparing the ground) for the innovation, three phases of early planning and action steps within each are listed to serve as a guide and a general checklist. Conclusion : As the curriculum with its implications constitutes the driving force for establishing the schools, it has been given due emphasis and greater share in planning. The communication is concluded with further advice to founding Deans through the proposition of a five-star Dean.

Objective: To determine whether measurement of access to existing child health clinics, and modelled location of new clinics, was affected by the spatial definitions of the target population. Method: Populations requiring childhood screening services were defined as located at individual households, and at geographic and population-weighted centroids of small and large areas. Straight-line and network distances were measured and compared from these origins to varying numbers of existing clinics. The same origins were used to model sets of locations for new clinics, and access levels were again compared. Results: Travel distances for 82,499 annual baby-visits to 140 existing clinics were between 136,000 km and 84,000 km, depending on origin definition. An analysis based on small area centroid data was as accurate as one based on household data. Planning solutions for new clinics located on the basis of few large areas, with populations centred at spatially defined centroids, resulted in poorer access for the population (231,000 km of travel) than one based on many small areas with populations centred at population weighted centroids (194,000 km of travel). Implications: Public access to health facilities will be improved if decisions about their locations are aided by the application of spatial analysis techniques based on small area definitions.

Insight into the conversion process raises questions of public involvement, mission, tax status, hoard composition, and conflict of interest for newly formed conversion foundations.

Legislation proposed to “protect” tax-exempt hospitals may actually hamper their ability to compete, says Columbia/HCA executive.

O of the major i ssues inherent in the acquisition of nonprofit hospitals by for-profit companies is the process by which these conversions occur. The resurgence of conversions of nonprofit hospitals to for-profit status represents the largest potential redeployment of charitable assets in the nation’s history. Conversion activity, in turn, signals significant change in the structure of the health care industry in general and will affect the health care delivery systems in hundreds of communities across the country. Some analysts argue that the sale of notfor-profit hospitals to for-profit chains will reduce the nation’s oversupply of hospital beds and the high costs associated with them. Even if this argument proves to be true, the selling off of not-for-profit hospital assets raises numerous other issues regarding how these sales are occurring and who is getting rich from the proceeds.

PROLOGUE: The conversion of nonprofit health plans to for-profit status, or the acquisition of nonprofit hospitals by for-profit chains hungry for market share, continues to attract nationwide attention. Although the numbers are still small, the potential for more conversions and the enormous amount of money at stake demand policy attention. The authors of this overview paper offer some guidance through the morass of public opinion, legal precedent (or lack thereof), detailed financial transactions, emotional reactions, and other aspects of the topic of health plan conversions. Gary Claxton is a senior manager of The Lewin Group in Fairfax, Virginia. He joined Lewin's public policy practice after spending ten years in state and federal health policy positions, most recently in the U.S. Department of Health and Human Services. Judith Feder served as a key health reform adviser in the Clinton administration. She is a professor of public policy at Georgetown University's Institute for Health Care Research an...

For-profit health care enterprises are not inherently evil, says Ohio's assistant attorney general Nevertheless, vigilant oversight of conversions is needed.

The aim of this project is to establish an ambulatory and semi-ambulatory community care center for the elderly. We intend to keep the elderly on their own homes for as long as possible while at the same time minimizing the cost of caring for them, maintaining their autonomy, and permitting them to live and die with dignity in their own homes. The present paper outlines the principles of organizing this new institution and its working conditions.

Aim: A complex interaction between several factors may influence and explain the variance in outcome after traumatic brain injury (TBI). The overall aim of this thesis was to explore, in individuals with severe TBI, the impact of posttraumatic hypopituitarism (PTHP), a history of unemployment or sick leave, and care pathways on long-term global outcome. Further, to investigate short- and long-term all-cause mortality after severe TBI. Methods: The studies reported in this thesis included a total of 280 participants with severe TBI. In study I and II, a retrospective follow-up was performed of 51 consecutive individuals, age 16–65 years, who were admitted with severe TBI to Sahlgrenska University Hospital, Gothenburg, from 1999 to 2002.The impact of PTHP and of unemployment or sick leave before injury on functioning and health related quality of life (HRQL) was explored. Data from the time of injury were combined into a validated prognostic model to adjust for injury severity. Outcome was measured once, 2 -11 years after trauma, and included hormonal testing, the Short Form-36 Health Survey, the Glasgow Outcome Scale –Extended (GOSE), and a self-report questionnaire specifically designed for these studies. Data on sick leave and unemployment were gathered from the Swedish social insurance agency. Study III was a multi-centre, prospective, observational study of 114 individuals, age 18-65 years, with severe TBI from six neurosurgical centers in Sweden and Iceland, with a follow up one year after the injury. The study assessed the relationship between care pathways (length of stay in intensive care, time between intensive care discharge and rehabilitation admission), and global outcome (GOSE). A validated prognostic model was used to adjust for injury severity. In study IV, a comparison of the cumulative death rates and causes of death between 166 individuals admitted to Sahlgrenska and a community control group, was conducted retrospectively at 10 years after the severe TBI. The data was ascertained from the Swedish National Board of Health and Welfare register. Results: A history of sick leave or unemployment before severe TBI was found to predict a worse long-term global outcome, more problems with activities of daily living and reduced HRQL at follow-up. A higher body mass index and overweight at follow-up was partially explained by PTHP. Otherwise no significant correlation was found between PTHP, functioning and HRQL. A longer length of stay in intensive care, and longer time between discharge from intensive care and admission to inpatient rehabilitation, were both associated with a worse global outcome at one year after injury. The risk of death was increased from a variety of causes for at least 10 years after severe TBI. Conclusion: The participants with severe TBI reported lasting disability, and low HRQL, with a complex range of physical, cognitive, behavioral and emotional disturbance. This may increase risk for secondary medical morbidity and explain the increased risk of death for many years after the injury. The results of the studies should be considered when refining long-term outcome predictions and optimizing rehabilitation interventions (prevention, surveillance and treatment) and care pathways after severe TBI. These findings highlight the need to provide special interventions for individuals with a history of unemployment or sick leave before severe TBI and they indicate that screening for PTHP might be warranted to specific subgroups such as overweight individuals. Measures to establish well-timed rehabilitation admission may improve outcomes after severe TBI.

The paper presents an external respiratory failure (ERF) classification, a scientific rationale for its use in the clinical practice of departments of different profiles. The setting up of interclinical functional diagnostic laboratories and preventive health care facilities for the preclinical diagnosis of ERF is substantiated. The introduction of the classification of ERF into wide clinical practice is intended to form a social order for the design and purchase of diagnostic equipment for therapeutic-and-prophylactic institutions and to stimulate researches in clinical respiratory physiology, and to improve physicians' knowledge of this section of clinical science.

Em 2001, as equipes de Saúde Bucal passaram a ser incorporadas à Estratégia Saúde da Família no Brasil, aumentando progressivamente a sua quantidade ao longo dos anos. Além disso, estudos têm demonstrado melhora no acesso da população aos serviços odontológicos. Entretanto, a relação entre oferta e uso de serviços de saúde não está bem esclarecida. O objetivo deste trabalho é descrever e analisar a associação entre a cobertura de equipes de saúde bucal da Estratégia Saúde da Família (ESB/ESF) e o uso de serviços odontológicos públicos nos municípios brasileiros de 1999 a 2011. É um estudo ecológico longitudinal, cuja amostra contou com todos os 5507 municípios brasileiros. Foram utilizados dados secundários oriundos principalmente do DATASUS, e procedeu-se à análise multivariada de regressão logística. Observou-se que 85% dos municípios possuíam ESB/ESF em 2011 e houve aumentos nas taxas de recursos físicos, humanos e financeiros. A produção odontológica aumentou 49,5% no período. Os municípios que incorporaram >3 ESB/10mil habitantes tiveram mais chances de aumentar as taxas de procedimentos coletivos (OR=1.61, IC95%: 1.23-2,11), preventivos (OR=2.05, IC95%: 1.56-2,69), restauradores (OR=2.07, IC95%: 1.58-2,71), e de extração (OR=1.53, IC95%: 1.19-1.97), após controle por fatores sócio-demográficos e relacionados à variação de recursos físicos, humanos e financeiros. Conclui-se que a incorporação de ESB à Saúde da Família parece mais eficiente para o aumento do acesso da população aos serviços odontológicos. In 2001, the oral health teams began to be incorporated into the Family Health Strategy in Brazil, progressively increasing its amount over the years. Furthermore, studies have shown improvement in the population's access to dental services. However, the relationship between supply and use of health services is not well established. The objective of this study is to describe and analyze the association between coverage of oral health teams of the Family Health Strategy (OHT) and the use of dental services in Brazilian municipalities from 1999 to 2011. It is a longitudinal ecological study, whose sample included all 5507 municipalities. Data were collated from information systems and analyzed with logistic regression for the increase in rates of dental procedures. Secondary data were derived from information systems, and proceeded to the multivariate logistic regression analysis. It was observed that 85 % of municipalities had OHT in 2011 and there were increases in the rates of equipments, human and financial resources. The rates of dental procedures increased 49.5% in the period. Municipalities that incorporated >3 OHT/10 thousands inhabitants were more likely to increase rates of collective procedures (OR=1.61, 95% CI: 1.23-2,11) , preventive (OR=2.05, 95% CI: 1.56-2,69 ) restorations (OR=2.07, 95% CI: 1.58-2,71), and extractions (OR=1:53, 95% CI: 1.19-1.97) after adjusting for socio-demographic factors and increased in equipments, human and financial resources. It is concluded that the incorporation of OHTs are a more efficient way to increase the population's access to dental services.

Many rural hospitals have closed or converted to organizations that provide health services other than general, acute inpatient care. However, little is known about why rural hospitals convert rather than close. This study evaluates the relationship between state policy and rates of rural hospital conversion relative to rates of rural hospital closure. The expectation was that the relationship among state policies and rates of conversion and rates of closure differs as a function of whether a state policy facilitates rural hospital transition to alternative models of care or supports them in their existing form. National data were analyzed for all rural hospitals from 1984 to 1991. Results indicate that state policies have done little to facilitate widespread adoption of conversion among rural hospitals. Despite these findings, results also indicate that some state policies have resulted in an increase in the rate of rural hospitals conversions as an alternative to closure.

One of the major causes of maternal mortality is the distance and consequent delay in treatment of childbirth complications. Some developing countries are attempting to reduce delays in treatment by moving women at risk into maternity waiting homes (MWHs), located near a hospital, a few days prior to the date of confinement. This paper illustrates some typical examples of MWHs in different countries. The approach of MWHs is appropriate in some settings but it requires a high degree of coordination between peripheral prenatal care services and second and third level health care facilities. This study discusses some of the issues related to the successful functioning of MWHs, and provides an analytical framework for the planning, management and evaluation of these facilities.

The new political era in South Africa offers unique opportunities for the development of more equitable health care policies. However, resource constraints are likely to remain in the foreseeable future, and efficiency therefore remains an important concern. This article describes the guiding principles and methods used to develop a coherent and objective plan for comprehensive primary health care facilities in Soweto. The article begins with an overview of the context within which the research was undertaken. Problems associated with planning in transition are highlighted, and a participatory research approach is recommended as a solution to these problems. The article goes on to describe how the research methods were developed and applied in line with the principles of participatory research. The methods were essentially rapid appraisal techniques which included group discussions, detailed checklists, observation, record reviews and the adaptation of international and local guidelines for service planning. It is suggested that these methods could be applied to other urban areas in South Africa and elsewhere, and that they are particularly appropriate in periods of transition when careful facilitation of dialogue between stakeholders is required in tandem with the generation of rapid results for policy-makers.This paper describes the guiding principles and methods used to develop a coherent and objective plan for comprehensive primary health care facilities in Soweto. An overview of the context within which the research was conducted is first presented. Problems associated with planning in transition are then outlined and a participatory research approach recommended to solve them. The authors describe how the research methods were developed and applied according to the principles of participatory research. The methods used were largely the rapid appraisal techniques of group discussion, detailed checklists, observation, record reviews, and the adaptation of international and local guidelines for service planning. These methods could be applied to other urban areas in South Africa and elsewhere. They are especially appropriate during periods of transition when the careful facilitation of dialogue between stakeholders is required together with the generation of rapid results for policymakers.

The Ministry of Health and Ministry Responsible for Seniors in British Columbia, Canada, has developed a comprehensive and integrated service delivery system for the care of the elderly and the disabled. This system has a single point of entry, and contains all of the major components of Long- Term Care and Home Care services under one administrative umbrella, the Continuing Care Division. This paper presents an overview of the Division’s service delivery system and its planning framework. The latter provides a vehicle for decision makers to pro- actively re- allocate resources from residential services to community and home- based services within Continuing Care. (Aging Clin. Exp. 7: 94–109, 1995).

There are approximately 5,700 hospitals in the United States, 3,000-4,000 that are antiquated or obsolescing. To meet increased service demands, remain financially viable; meet needs to upgrade aging infrastructure and incorporate medical and technology advancements, healthcare facilities are in a perpetual state of construction. Outbreaks of nosocomial infections have historically been documented in association with construction and renovation actives within health care facilities. For most healthy individuals, environmental exposures to etiological agents, results in no adverse effects but in immune-compromised patient, they are left susceptible to inadvertent exposures during construction to opportunistic bacteria, fungi and viruses. Evidence scientifically linking construction work and nosocomial infections as well as the efficacy and clinical relevance of infection control precautions is somewhat lacking but the empirical evidence and recommendations to support protective measures is steadily growing. Opening a "Pandora's Box" during construction can unleash unintended consequences therefore; it is imperative that a thorough, multidisciplinary approach towards an infection control plan is put clearly and firmly in place allowing health care construction projects to move forward with confidence that patient safety is the first specification.

Hurricane Katrina destroyed much of the health care infrastructure in and around New Orleans in 2005.We describe a natural experiment that occurred afterward, amid efforts to rebuild the city's health care system, in which diverse safety-net clinics were transformed into medical homes. Using surveys of clinic leaders and administrative data, we found that clinics made substantial progress in implementing new clinical processes to improve access, quality and safety, and care coordination and integration. But there was wide variation, with some clinics making only minimal progress. Because the transformation was closely tied to the receipt of federal grants and bonus payments, we observed declines in performance toward the end of the study, when clinics faced diminished federal funding and refocused their priorities on survival. Now that federal funds have dried up, moreover, clinics may be losing ground in sustaining their practice changes. The experience shows that payment to support medical home transformation must be robust and stable, and clinics need to be fully integrated into the broader health care system to improve overall coordination of care. © 2012 Project HOPE-The People-to-People Health Foundation, Inc.

In response to the enactment of the Government's Health and Social Care Bill, and following a 'period of transition' in the Department of Health, the NHS Estates and Facilities Policy Division has outlined an 'agenda' that sets out its key responsibilities and functions as the health service enters a new era. HEJ editor, Jonathan Baillie, met with Peter Sellars, the Division's new head of profession within the DH, to talk through the agenda, and discuss how the Division will work with, and support, estates professionals going forward to ensure that patients continue to receive care in high quality, clean, safe, fit-for-purpose buildings. The Division's new 'position' within the Department follows an 18-month consultation which identified what stakeholders including healthcare estates and facilities professionals, Institutes and trade associations, and Royal Colleges, felt were the sector's most pressing issues over the next 5-10 years.

Where and how can we best care for oncology patients, and what are the models of care that will provide safe patient and family-centered care while containing costs? Because the majority of all cancer care is delivered in the outpatient setting, the types of outpatient oncology settings, the services provided, and the advantages and disadvantages of different types of clinics are important considerations.

The Neurological Institute at University Hospitals Case Medical Center is designed to be responsive to the ever-changing healthcare environment, aligning clinical services and goals in response to internal and external pressures for change. These goals are many, including the further development of system integration across disciplines and geographic locations, creation of a regional strategy, and research as well as education strategies that are aligned with clinical services, patient outcomes that demonstrate improved health status management, and improved financial strength. There are many details to the development of a strategic business unit such as the Neurological Institute, but this article focuses on the high-level strategies of developing the Neurological Institute and takes a closer look at the growth of one of its 16 centers of excellence.

It has been said that the only people who like change are babies with wet diapers. This statement rings true whether it involves designing and building a new hospital, an additional tower, or even renovating an existing unit. It seems that we have great difficulty letting go of what is familiar even when the familiar does not work well. In a recent article, one chief nursing officer expressed surprise that physicians and staff who were heavily involved in the design of a new children's hospital were voicing discontent about the design once the building was open and functional (Stichler, 2008). How could this be? Some were the very same people who met with the design teams, participated in the design decisions, and even signed off on documents indicating their approval of the design.Unfortunately, this is not an isolated incident. Even with the excitement of opening a new building, people resist change. It is likely that there are few organizational initiatives that can compare to the change process that occurs with the design and opening of a new hospital, yet few organizational leaders provide the same due diligence to the change process as they do to structural change. The change associated with individual and organizational adaptation to moving into a new environment is complex and convoluted, and the change process must be as carefully orchestrated as the design process as a whole. Organizational leaders must guide physicians and staff through the process of discarding their current realities, introduce new practice patterns, and encourage the adoption of new behavioral paradigms. Moving into a new facility forces organizational culture change even when such change is not anticipated.Leading Change Using Classic Change TheoriesLeading change is one of a leader's most important and difficult roles. Although there are many excellent change theories that can be used to guide the change process, not all change is alike, nor can all organizational changes be approached in the same way to yield expected results. Perhaps the greatest failure is not addressing the change process at all and expecting everyone to be excited about a new facility. Using change theories as a framework for developing the structure and process of organizational change can enhance positive adaptation to a new patient care environment.Lewin's Change TheoryLewin was the first to develop the notion that change should be planned rather than allowing unintentional or accidental processes to occur, and he first described three levels of change: unfreezing, changing, and refreezing (Lewin, 1951). This classic theory still guides many planned organizational processes with great success. Using this theory, an organization's leaders would first demonstrate the need to change and explain why maintaining the status quo would be detrimental to patients, employees, the organization, and even the community. Kotter (1995) would describe this as creating a "sense of urgency." At the same time, leaders must assess an organization's readiness for change and identify those who may be resistant to the vision and "trench in" to the current status, situation, or even care delivery models.Applying the unfreezing stage of Lewin's theory, physicians and staff must be motivated to change by means of exposure to new ideas and creating a sense of urgency around the shared vision of how patient care outcomes and the work environment could be enhanced by the proposed change. The critical step of developing a shared vision is not only important in the design process, but it is also a critical part of the change process that must be orchestrated concurrently with the design and construction phases of a new facility. In the unfreezing stage, leaders at the departmental level must begin to examine existing work flow processes and design new processes in the context of the new building, equipment, or departmental relationships. Some healthcare professionals might need orientation to new equipment or have to be certified to perform new procedures or patient care activities that result from the changes in facility design or processes. …