The Work of Hospitals, a volume on hospitals as clinical and social institutions, foregrounds the tensions inherent in efforts to sustain functional health services in resource-poor states. Global ethnographic research shows how clinicians and patients struggle, without adequate supplies and personnel, in times of financial austerity. The chapters document a vast gulf worldwide between the idealized mission of the hospital and the implementation of this mission in everyday practice.
A Lean Action Workbook from the Lean Enterprise Academy, a affiliate of the Lean Global Network and the Lean Enterprise Institute For the first time, Making Hospitals Work provides a practical road map for healthcare leaders seeking to create truly lean hospitals. It outlines a clear framework for focusing improvement activities on the most important challenges facing each hospital. It uses the same evidence-based, scientific method as clinicians use to diagnose and treat medical problems to analyze and redesign the core emergency and elective patient journeys from arrival to discharge. It opens everyone's eyes to the big win-win-win opportunities to eliminate unnecessary waiting time for patients, to synchronize activities so clinical staff can spend more time caring for patients, and to free up capacity by reducing length of stay and cut the overtime and agency budget. It also introduces the key new role of the value-stream manager in gaining agreement on what needs to be done by whom in every department across the hospital. Every step described in Making Hospitals Work has been tried and tested in the three years' action research that led to this workbook. It is the critical breakthrough to take the next steps on the lean healthcare journey.
Hospitals and nursing homes are responding to changes in the health care system by modifying staffing levels and the mix of nursing personnel. But do these changes endanger the quality of patient care? Do nursing staff suffer increased rates of injury, illness, or stress because of changing workplace demands? These questions are addressed in Nursing Staff in Hospitals and Nursing Homes, a thorough and authoritative look at today's health care system that also takes a long-term view of staffing needs for nursing as the nation moves into the next century. The committee draws fundamental conclusions about the evolving role of nurses in hospitals and nursing homes and presents recommendations about staffing decisions, nursing training, measurement of quality, reimbursement, and other areas. The volume also discusses work-related injuries, violence toward and abuse of nursing staffs, and stress among nursing personnelâ€"and examines whether these problems are related to staffing levels. Included is a readable overview of the underlying trends in health care that have given rise to urgent questions about nurse staffing: population changes, budget pressures, and the introduction of new technologies. Nursing Staff in Hospitals and Nursing Homes provides a straightforward examination of complex and sensitive issues surround the role and value of nursing on our health care system.
Nursing is typically understood, and understands itself, as a care-giving occupation. It is through its relationships with patients – whether these are absent, present, good, bad or indifferent – that modern day nursing is defined. Yet nursing work extends far beyond direct patient care activities. Across the spectrum of locales in which they are employed, nurses, in numerous ways, support and sustain the delivery and organisation of health services. In recent history, however, this wider work has generally been regarded as at best an adjunct to the core nursing function, and at worse responsible for taking nurses away from their ‘real work’ with patients. Beyond its identity as the ‘other’ to care-giving, little is known about this element of nursing practice. Drawing on extensive observational research of the everyday work in a UK hospital, and insights from practice-based approaches and actor network theory, the aim of this book is to lay the empirical and theoretical foundations for a reappraisal of the nursing contribution to society by shining a light on this invisible aspect of nurses’ work. Nurses, it is argued, can be understood as focal actors in health systems and through myriad processes of ‘translational mobilisation’ sustain the networks through which care is organised. Not only is this work an essential driver of action, it also operates as a powerful countervailing force to the centrifugal tendencies inherent in healthcare organisations which, for all their gloss of order and rationality, are in reality very loose arrangements. The Invisible Work of Nurses will be interest to academics and students across a number of fields, including nursing, medical sociology, organisational studies, health management, science and technology studies, and improvement science.
In the context of neoliberalism and global austerity measures, health care institutions around the world confront numerous challenges in attempting to meet the needs of local populations. Examples from Africa (including, Ethiopia, Ghana, and Congo), Latin America (Peru, Mexico, Guatemala), Western Europe (France, Greece), and the United States illustrate how hospitals play a significant role in the social production of health and disease in the communities where they are. Many low-resource countries have experienced increasing privatization and dysfunction of public sector institutions such as hospitals, and growing withdrawal of funding for non-profit organizations. Underlying the chapters in The Work of Hospitals is a fundamental question: how do hospitals function lacking the medications, equipment and technologies, and personnel normally assumed to be necessary? This collection of ethnographies demonstrates how hospital administrators, clinicians, and other staff in hospitals around the world confront innumerable risks in their commitment to deliver health care, including civil unrest, widespread poverty, endemic and epidemic disease, and supply chain instability. Ultimately, The Work of Hospitals documents a vast gulf between the idealized mission of the hospital and the implementation of this mission in everyday practice. Hospitals thus become “contested space” between policy and practice.
Hospital and Healthcare Security, Fifth Edition, examines the issues inherent to healthcare and hospital security, including licensing, regulatory requirements, litigation, and accreditation standards. Building on the solid foundation laid down in the first four editions, the book looks at the changes that have occurred in healthcare security since the last edition was published in 2001. It consists of 25 chapters and presents examples from Canada, the UK, and the United States. It first provides an overview of the healthcare environment, including categories of healthcare, types of hospitals, the nonhospital side of healthcare, and the different stakeholders. It then describes basic healthcare security risks/vulnerabilities and offers tips on security management planning. The book also discusses security department organization and staffing, management and supervision of the security force, training of security personnel, security force deployment and patrol activities, employee involvement and awareness of security issues, implementation of physical security safeguards, parking control and security, and emergency preparedness. Healthcare security practitioners and hospital administrators will find this book invaluable. - Practical support for healthcare security professionals, including operationally proven policies, and procedures - Specific assistance in preparing plans and materials tailored to healthcare security programs - Summary tables and sample forms bring together key data, facilitating ROI discussions with administrators and other departments - General principles clearly laid out so readers can apply the industry standards most appropriate to their own environment NEW TO THIS EDITION: - Quick-start section for hospital administrators who need an overview of security issues and best practices
We are on the verge of the nation's worst nursing shortage in history. Dedicated nurses are leaving hospitals in droves, and there are not enough new recruits to the profession to meet demand. Even hospitals that were once very highly regarded for the quality of their nursing care, such as Boston's Beth Israel Deaconess Medical Center, now struggle to fill vacant positions. What happened? Dana Beth Weinberg argues that hospital restructuring in the 1990s is to blame. In their attempts to retain profit margins or even just to stay afloat, hospitals adopted a common set of practices to cut costs and increase revenues. Many strategies squeezed greater productivity out of nurses and other hospital workers. Nurses' workloads increased to the point that even the most skilled nurses questioned whether they could provide minimal, safe care to patients. As hospitals hemorrhaged money, it seemed that no one—not hospital administrators, not doctors—felt they could afford to listen to nurses. Through a careful look at the effects of the restructuring strategies chosen and implemented by Beth Israel Deaconess Medical Center, the author examines management's efforts to balance service and survival. By showing the effects of hospital restructuring on nurses' ability to plan, evaluate, and deliver excellent care, Weinberg provides a stinging indictment of standard industry practices that underestimate the contribution nurses make both to hospitals and to patient care.
Views nursing as a classic case of the oppression of women and maintains that the prevalent misuse of the nurse's skills has undermined the nation's health care system
Provides eyewitness accounts and personal stories demonstrating how nurses turn the awesome into the routine. Chambliss shows how patients-- many weak and helpless--too often become objects of the bureaucratic machinery of the health care system, and how ethics decisions--once the dilemmas of troubled individuals--become the setting for political turf battles between occupational interest groups. The result is a combination of realism with a theoretical argument about moral life in large organizations. --From publisher description.
