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Byline: Joseph A. Flear, Donald A. Person, Gregory J. Dever This paper describes the use of medical technology and telemedicine to provide healthcare to a population of over 400,000 Micronesian and American Samoan who live on islands scattered over the Pacific Ocean, in an area equal to that of the USA. Low cost communication technologies were used to provide this population with medical consulting and distance medical learning. The paper describes a case of such usage, and lists the initial steps taken to institute a continuing program of telemedicine in Micronesia and the Pacific Islands.

As a linear programming technique that is used to assess performance efficiency among organizational units, data envelopment analysis (DEA) has the practical value for planners to identify the most efficient units and thus project a best possible course of actions. This is also the fundamental goal of Six Sigma methodology for process improvement. Therefore, it is natural to integrate the DEA method into the framework of Six Sigma to enhance both the usefulness of Six Sigma and the effectiveness of DEA for assessing and improving health service efficiency. In this paper, the implementation of DEA is well incorporated into the Define, Measure, Analyze, Improve and Control process. The procedure can be well fitted into the Blackbelts training curriculum, which can also serve as a roadmap for Six Sigma practitioners to implement the DEA-enhanced projects. To illustrate how to integrate DEA into the Six Sigma framework, we present a Six Sigma project implemented to measure physician productivity in a clinical department. Journal of the Operational Research Society (2010) 61, 1112-1121. doi: 10.1057/jors.2009.61 Published online 17 June 2009 Keywords: data envelopment analysis (DEA); Six Sigma; DMAIC; physician productivity; health service efficiency

Cross-functional teams (CFTs) play an increasingly important role in health care. However, despite their potential, CFTs often fail to function effectively. This paper contributes to the literature in medical sociology by examining how the steep and well-defined hierarchy characteristic of the health occupations proves to be dysfunctional in the CFT setting. Previous research has shown that status differences among members of work teams negatively affect their functioning. Yet the specific mechanisms that connect variations in status to poor team functioning remain unclear. We hypothesize that it is the suppression of participation among low status team members that leads to poor CFT functioning. Our theoretical model integrates status characteristics theory and the value attainment theory of job satisfaction to link team members' statuses to participation in team decision-making and, ultimately, to their attitudes about the job. We use causal modeling to test our hypotheses. Our results indicate that relationships between health professionals defined in broader social contexts affect status, roles, and functions within CFTs, and these, in turn, affect the team's interpersonal processes. We suggest changes in organizational structure and in team leadership styles that might make CFTs more effective.

Toronto, New York, Oxford: Oxford University Press, 1996, viii + 245 pp., $19.95 paper. As illustrated by the title, Wasting Away is a dire forecast of the current condition of [...]

The paper highlights the grossly inadequate provision of library and literature information services for health care staff in the developing countries. It identifies the different types of information needs (current awareness, clinical inquiries) and makes suggestions how these could be met by simple and inexpensive means. The various administrative, organizational and financial problems that may have to be overcome are discussed. Hope is expressed that at medium or longer term more sophisticated services will become feasible through the application of information technologies.

This paper introduces analyses of the state of health and of the health-care system in four Eastern European countries. The analyses focus on the issue of inequality in countries which share many characteristics including non-market economies, rapid urbanization and industrialization, and health systems which formally aim to provide equal access and treatment to all citizens. The measurement of social inequality in a non-market economy dominated by the state economy cannot be based on traditional class divisions; nor is income a good indicator of class position, salaries for professional and non-manual workers being lower than the average. Major relevant variables for which data are available are occupation, educational level and area of residence. Despite many system similarities the countries differ sharply in the level of resources devoted to health care and in health status based on mortality rates.

Byline: Urs E. Gattiker, Rainer Fahs, Jaroslav Blaha Rapid cost escalation in healthcare has forced governments and associated businesses to reduce or at least contain rising healthcare costs. One viable approach has been to improve medical record keeping and its accessibility by parties involved in care taking and administration. Divergent stakeholder demands for information and its privacy may result in conflicts between parties (e.g., insurers versus patients). Encryption technology may help to protect the privacy and confidentiality of patients' information. Unfortunately, governments demand to be given the possibility of intercepting and monitoring such electronic data transfer for administrative, legal and law enforcement purposes, should the need arise, is threatening the privacy of patients. This paper reviews these issues and highlights some of the problems and pitfalls various stakeholders are faced with considering medical information, privacy, encryption and law enforcement needs in an international context. Implications for managers and system specialists are described, and how these issues may affect direct marketing, customer databases and electronic commerce is discussed.

Byline: Bahador Ghahramani The Total Quality Management (TQM) model presented in this paper is a Systems Engineering (SE) approach that is customer driven and adheres to continuous quality improvement principles. If the TQM model is implemented, it can significantly and objectively increase efficiency, productivity and profit margins of care providers in the Healthcare Industry (HCI). The SE approach to TQM is a paradigm shift in the HCI because it is a model that is not currently used or implemented by the care providers. The model is customer driven and results oriented rather than based on individual employee performance. The model also derives from the basic SE premise that the HCI cannot effectively provide service care for its patients unless it is based on patient needs and satisfaction. This model is an evolutionary and objective approach to an industry that is in urgent need of improvements and is currently too costly to operate.

Byline: Penny A. Jennett, Eugene Igras, Alexandra C. Harrison, Kalyani Premkumar In this time of significant change in the health system and in the delivery of health care, the effective and efficient management of a network of health services is particularly challenging. Health information network systems are seen to be keys to tying delivery sites, patients and providers together across a continuum of care. This paper describes a regional health information system designed to serve one of 17 health regions in the Province of Alberta, Canada. The functions, architecture, and implementation strategies for the system are detailed. The information system is seen to play a prominent role in strategic, tactical, administrative, management and educational initiatives, and will cover all business functions carried out by a healthcare delivery system. The foundation of future effective health information systems may be characterised by elements of the design, applications and architecture described in this regional health information technology approach.

Much has been written about how to communicate with patients, but there has been little critical scrutiny of this literature. This paper presents an analysis of publications about the use of patient information leaflets. It suggests that two discourses can be distinguished in this literature. The first of these is the larger of the two. It reflects traditional biomedical concerns and it invokes a mechanistic model of communication in which patients are characterised as passive and open to manipulation in the interests of a biomedical agenda. The persistence of the biomedical model in this discourse is contrasted with the second discourse, which is smaller and more recent in origin. This second discourse draws on a political agenda of patient empowerment, and reflects this in its choice of outcomes of interest, its concern with the use of leaflets as a means of democratisation, and its orientation towards patients. It is suggested that the two discourses, though distinct, are not entirely discrete, and may begin to draw closer as they begin to draw on a wider set of resources, including sociological research and theory, to develop a rigorous theoretically grounded approach to patient information leaflets. Keywords: Patient information; Discourse; Patient empowerment

ABSTRACT Background Providing reassurance is one of physicians' most frequently used verbal interventions. However, medical reassurance can fail or even have negative effects. This is frequently the case in patients [...]

Epidemiologists and environmental health researchers have a joint responsibility to acquire scientific knowledge that matters to public health and to apply the knowledge gained in public health practice. We examine [...]

President William Clinton kept one of his most important campaign promises when he appointed a taskforce to formulate a proposal to reform the healthcare delivery system of the USA by [...]

I. Introduction An important type of regulatory failure occurs when agencies neglect to coordinate their actions. A growing body of research has found that coordination failures confound government efforts to [...]

In a new approach, these major employers have stopped looking for the cheapest health care. Now they're demanding the best. Last year, 14 Minnesota-based corporations announced they would no longer [...]