Journal of health and human services administration
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J Health Hum Serv Adm · Jan 1999
Burnout among leaders of Department of Veterans Affairs medical centers: contributing factors as determined by a longitudinal study.
Significant increases in the intensity of psychological burnout among leaders of local Department of Veterans Affairs (VA) medical centers occurred from 1989 to 1997. This longitudinal study was designed to analyze which demographic and behavioral variables were associated with the intensity of burnout. Responses of 83 Medical Center Directors, Associate Directors, and Chiefs of Staff to questionnaires sent in 1989, 1992, and 1997 were analyzed using path analysis. ⋯ If consequences and antecedents were included in the model, burnout phase in 1997 was inversely related to job satisfaction and resource availability and directly related to intent to stay in the VA in 1989. Findings demonstrated that specific demographic and job site characteristics are associated with high levels of burnout in the VA. These could form the basis for interventional efforts.
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Health care reform in Italy is transforming its centrally planned, vertically integrated National Health Service into a market-oriented system in which public funders contract directly with individual providers. A model is envisaged in which a plurality of public and private care providers compete for contracts with capitated health agencies responsible for assuring uniform levels of services for geographically defined populations. The ultimate goal of the reform is to guarantee universal coverage and secure global spending limits while, at the same time, promoting efficiency in the delivery of care and enhancing responsiveness to consumers. ⋯ It creates the need for developing rules to make competition manageable and providing sound clinical and financial information that make enforcement possible. The poor record scored in managing the contractual relationships between the LHUs and the strong private health sector suggests that massive investment in promoting managerial skills and developing appropriate clinical and financial information systems are required. Careful experimentation in implementing the reform and continuous monitoring of its impact on the health care system are, therefore, the imperatives of the next two years.
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J Health Hum Serv Adm · Jan 1998
Analysis of comfort care for the terminally ill: the hospice approach.
Much of the published literature on hospice care focuses on a single dimension of this increasingly popular approach to meeting the needs of the terminally ill. By contrast, this article takes a broader view by examining the hospice concept and its implementation through the lens of the nine dimensions of the SEPTEMBER model--focusing in turn on each of the social, economic, political, treatment, ethical, managerial, bereavement, education, and research elements. This broader perspective brings together in kaleidoscopic fashion these diverse but interconnected elements of hospice care. This integrated conceptual model helps administrators and health care professionals to develop a clearer overall picture of the multifaceted challenges involved in delivering palliative care to dying patients.