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The Veterans Healthcare Administration (VHA) has promoted Specialty Care Neighborhoods (SCN) to enhance the coordination of services between primary and specialty care…
The Veterans Healthcare Administration (VHA) has promoted Specialty Care Neighborhoods (SCN) to enhance the coordination of services between primary and specialty care. Care coordination agreements (CCAs) were included as a critical element in the SCN program. The purpose of this paper is to examine the role of these documents in the successful implementation of SCNs.
Content, quality, and perceived usefulness of CCAs from 19 SCN sites were evaluated. CCA content was defined as the presence or absence of eight key components: contact information, process for urgent consults, process for e-consults, content of consults, primary and specialty care responsibilities, expected response time, discharge criteria, and review criteria. CCA quality was based on a qualitative assessment of CCA content; and perceived usefulness was based on a qualitative assessment of interview responses from CCA users. CCA characteristics were compared to SCN implementation levels using descriptive statistics. SCN implementation level was defined and measured by VHA Specialty Care Services.
Participating sites with medium-high or high SCN implementation levels had CCAs with more key components and of higher quality than sites with medium-low to medium SCN implementation levels. Perceived usefulness of CCAs was not associated with implementation level.
Since this study built on a quality improvement effort to facilitate care coordination, a rigorous research approach was not used. Specific CCA components could not be examined nor could specific hypotheses be tested due to the small and diverse sample. Findings presented are only preliminary.
The examination of CCAs suggests that these documents may be helpful to improve communication among primary and specialty care providers by explicitly stating agreed upon processes, mechanisms and criteria for referrals, roles and responsibilities for the co-management of patients, and timelines for review of CCAs.
This small study suggests that high-quality CCAs, which include a number of key components, can facilitate the implementation of coordinated care. Key characteristics of CCAs are identified in this study, including measures of CCA content, quality, and usefulness, which can be used in future efforts to develop and evaluate efforts to improve care coordination.
One of the main functions of the absorptive class is to minimize the impact of economic crisis within a given national economy and where possible to shift the impact of…
One of the main functions of the absorptive class is to minimize the impact of economic crisis within a given national economy and where possible to shift the impact of economic crisis to less-developed or developing economies or indeed to another advanced economy. Hence the absorptive class displays the same feature of capitalism: it is simultaneously both national and international. This process of absorption is not done consciously, of course. It is the way the system has come to operate. Had the system not done so, capitalist economies would have lost a great degree of its capacity for resilience in the face of recurrent crises. Since the industrial revolution gathered momentum in England in the eighteenth century and spread rapidly to a limited number of countries in the world, economic crisis has been commonplace, threatening the very fabric of the economies created by the system. Economic crisis is taken to mean a severe disjuncture between production and consumption, marked by a reduction in economic growth. Depending on one's theoretical position economic crisis is caused by over-production or under-consumption or by some combination of the two. Adam Smith who published An Enquiry into the Wealth of Nations just about at the onset of the industrial revolution in England believed that any disjuncture between glut and scarcity was an effect of wrong-minded intervention by government. Left alone market forces would always tend toward the elimination of gluts. Thus, want of employment (the word unemployment was to be invented a 100 years later), so dangerous to the social fabric, would be avoided and capital accumulation would take place steadily in an unimpeded way. However, by the early nineteenth century, the British economy seemed to fluctuate ever more wildly than it had done in less industrial times, and as the urban population grew, such instability was especially feared by the ruling classes in Britain and, later, in Germany, the United States, France and Italy. Clearly, policy intervention by governments took place to manage such crises and the governments sought increasingly to achieve financial and price stability, and in Britain for instance this culminated in the Bank Charter Act of 1844, having 10 years previously introduced legislation aimed at achieving labour mobility with the infamous Poor Law Amendment Act.
The purpose of this paper is to identify how the newly emerging UK practice of “collaborative planning” (CP) for construction project delivery aligns with the advocated…
The purpose of this paper is to identify how the newly emerging UK practice of “collaborative planning” (CP) for construction project delivery aligns with the advocated principles of the global last planner system (LPS) of production planning and control.
A mixed, qualitative, exploratory approach was adopted for the study. This entailed qualitative data through three techniques, namely: semi-structured interviews, documents analysis, and structured observation. In total, 30 in-depth interviews were conducted over a 12 month period with lean construction consultants, clients, main contractors, and subcontractors drawn from the building, highways and infrastructure and rail sector. In all, 15 projects were visited where practices were observed.
The study reveals that the current practice of CP in the UK partially aligns with the LPS principles. Where practitioners have heard of the LPS they believe it to be the same practice as CP.
This study is limited to 30 interviews, observation of 15 projects and document analysis. The aim of the study is not to generalise the findings, however, since the study examined top construction companies and practitioners in the UK and the findings were consistent across the sample, some conclusions could be made. The study is also limited to examining the construction phase only, future studies should incorporate the design phase.
A clear identification of the elements of current practice compared to the components of the LPS provides a contribution to the future practice of project production planning and management in the construction industry.
The study highlights a continuing resistance to collaboration within the industry. This resistance is subtly embedded within implemented practices even though they are based on collaborative working for their success.
This is among the first studies in the UK that comprehensively examines and reports the application of LPS/CP practice in construction across the major construction sectors. Future studies could build on the findings from this work to develop an approach/methodology to improve the current practice.
The rapid globalization of modern business and the multicultural nature of its workforce pose major challenges for leadership and human resource management in 1990s. One…
The rapid globalization of modern business and the multicultural nature of its workforce pose major challenges for leadership and human resource management in 1990s. One important area that is yet to be fully explored is the managing of conflict in a multicultural organization where values, orientations, preferences, and attitudes differ significantly among the members. This paper explores the implications of cultural differences for managerial intervention in conflicts between subordinates in organizations using Hofstede's four‐dimensional framework.
Whether or not women have children has profound consequences for their employment experiences. Employers may see women with no children as conforming more closely than…
Whether or not women have children has profound consequences for their employment experiences. Employers may see women with no children as conforming more closely than women with children (and yet not as closely as male employees) to the pervasive ‘ideal worker’ stereotype of a full-time, committed worker with no external responsibilities. However, managers and co-workers may also perceive women with no children as deviating from prevailing pronatalist norms in Australian and other comparable societies, which construct and value women as mothers and stigmatise and devalue women with no children. Accordingly, women with no children may be rewarded or penalised in different employment contexts at different times according to the degree to which they conform to or deviate from the most salient characteristics associated with the ideal worker and mothering femininity. This chapter explores patriarchal and capitalist configurations of femininities, masculinities and workers as drivers of employment experiences among women with no children. It then discusses empirical research from Australia and comparable countries, in order to elucidate the diversity of employment experiences among women with no children.
This paper reports the application of an evidential reasoning (ER) approach, to deal with the evaluation of a contractor, from among different fabrication options of…
This paper reports the application of an evidential reasoning (ER) approach, to deal with the evaluation of a contractor, from among different fabrication options of aero‐engine equipment. This is followed by a review of current evaluation practices, which begins by highlighting their limitations and then goes on to justify the use of an evidential reasoning approach. The evaluation model is discussed and techniques for articulating the original evaluation data are also explored. A hypothetical selection problem involving the evaluation of different fabrication options for aero‐engine equipment is then examined using this approach. Given the role of small firms as sub‐contractors, and the difficulties that they face in managing the pricing part of the marketing mix, which is heightened when tendering is involved, this paper has lessons that extend outside of the particular industry that forms the case study. The case study itself draws from the real life experience of actual defence contract assessors.
The notes reproduced here were taken by Glenn Johnson in Lloyd Mints’ course on Money and Banking at the University of Chicago in the fall of 1946. Several additional sets…
The notes reproduced here were taken by Glenn Johnson in Lloyd Mints’ course on Money and Banking at the University of Chicago in the fall of 1946. Several additional sets of course notes taken by Glenn Johnson have been published in the archival volumes of Research in the History of Economic Thought and Methodology. These included notes from Frank Knight's course on economic theory (Volume 24C) and Albert L. Meyer's course entitled elements of modern economics (appearing in this volume). A brief biography of Glenn Johnson is provided in Volume 24C, along with notes from his course on Agricultural Economics Methodology taught at Michigan State University.
This project focuses specifically on how intercultural negotiating differences are evidenced communicatively. Evidence suggests that negotiators deal differently with internationals than domestics. Therefore, it is important to move beyond within‐culture comparisons as a basis for predicting intercultural negotiation processes. This paper tests empirically the endurance of culturally‐associated negotiation styles in inter‐cultural negotiations between Americans and Taiwanese. Results suggest that culture does exert some global effects in face‐to‐face encounters with cultural outsiders. Other aspects of negotiation are managed locally, so that predicted cultural differences do not emerge in interaction.