The Journal of nursing administration
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The restructuring of healthcare delivery systems has increased the demand for successful, low-cost, alternative approaches to providing care. The authors detail the design, implementation, and evaluation of one alternative approach for delivery of care to thoracic surgery patients. The authors describe the use of a stepdown unit for the care of patients 24 to 36 hours after cardiothoracic surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
The cost-effectiveness of a special care unit to care for the chronically critically ill.
To assess the relative value of healthcare programs, technologic innovations, and clinical decisions, policymakers are searching for ways to evaluate cost-effectiveness. What constitutes cost-effectiveness and how should it be measured? The authors discuss ways in which the cost-effectiveness of clinical programs can be measured and describes various methods of assessing both costs and effectiveness. Comparison of the cost-effectiveness of a nurse managed special care unit with that of traditional intensive care units illustrates some of these methods.
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The author discusses some of the problems and shortcomings of the process used by many outside consultants to assist hospitals reengineer their operations. The author calls this process the "form follows function" process because employees are involved extensively in redesigning job tasks (functions) that in turn change the organization's structure, positions, and reporting relationships (form). The author presents an alternative process called the "function follows form" model used by two consultants to assist six hospitals in a multihospital system reengineer their operations. The process resulted in documented quantifiable improvements in enhanced quality, service, and financial outcomes in the first year of implementation.
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Comparative Study
Technological and environmental characteristics of intensive care units. Implications for job redesign.
Nurse executives are experiencing severe pressures to create systems of care delivery that provide services in more cost-conscious ways. Before care systems can be restructured, a systematic assessment of the work and the environment of the nursing unit must take place. This study found significant differences among nine intensive care units regarding both the nature of their work and their environments. These differences provided information that can be used in staffing decisions, nurse/physician interaction, and staff nurse and managerial recruitment.