Hospital downsizing and workforce reduction strategies: some inner workings

2003 ◽  
Vol 16 (1) ◽  
pp. 13-23 ◽  
Author(s):  
Thomas P. Weil
Keyword(s):  
Economies Of Scale ◽  
Management Strategies ◽  
The United States ◽  
Direct Patient Care ◽  
Workforce Reduction ◽  
Minimal Impact ◽  
Physician Practices ◽  
Reduction Strategies ◽  
Managerial Strategies

Downsizing, manpower reductions, re-engineering, and resizing are used extensively in the United States to reduce cost and to evaluate the effectiveness and efficiency of various functions and processes. Published studies report that these managerial strategies result in a minimal impact on access to services, quality of care, and the ability to reduce costs. But, these approaches certainly alienate employees. These findings are usually explained by the significant difficulties experienced in eliminating nursing and other similar direct patient care-oriented positions and in terminating white-collar employees. Possibly an equally plausible reason why hospitals and physician practices react so poorly to these management strategies is their cost structure-high fixed (85%) and low variable (15%)-and that simply generating greater volume does not necessarily achieve economies of scale. More workable alternatives for health executives to effectuate cost reductions consist of simplifying prepayment, decreasing the overall availability and centralizing tertiary services at academic health centres, and closing superfluous hospitals and other health facilities. America's pluralistic values and these proposals having serious political repercussions for health executives and elected officials often present serious barriers in their implementation.

scholarly journals Assessing the Runoff Reduction Potential of Highway Swales and WinSLAMM as a Predictive Tool

2018 ◽  
Vol 10 (8) ◽  
pp. 2871 ◽  
Author(s):  
Bailee Young ◽  
Jon Hathaway ◽  
Whitney Lisenbee ◽  
Qiang He
Keyword(s):  
Green Space ◽  
Management Strategies ◽  
Field Measurements ◽  
The United States ◽  
Predictive Tool ◽  
Infiltration Rates ◽  
Runoff Reduction ◽  
Infiltration Parameter ◽  
Pollutant Discharge

Across the United States, the impacts of stormwater runoff are being managed through the National Pollutant Discharge Elimination System (NPDES) in an effort to restore and/or maintain the quality of surface waters. State transportation authorities fall within this regulatory framework, being tasked with managing runoff leaving their impervious surfaces. Opportunely, the highway environment also has substantial amounts of green space that may be leveraged for this purpose. However, there are questions as to how much runoff reduction is provided by these spaces, a question that may have a dramatic impact on stormwater management strategies across the country. A highway median swale, located on Asheville Highway, Knoxville, Tennessee, was monitored for hydrology over an 11-month period. The total catchment was 0.64 ha, with 0.26 ha of roadway draining to 0.38 ha of a vegetated median. The results of this study indicated that 87.2% of runoff volume was sequestered by the swale. The Source Loading and Management Model for Windows (WinSLAMM) was used to model the swale runoff reduction performance to determine how well this model may perform in such an application. To calibrate the model, adjustments were made to measured on-site infiltration rates, which was identified as a sensitive parameter in the model that also had substantial measurement uncertainty in the field. The calibrated model performed reasonably with a Nash Sutcliffe Efficiency of 0.46. WinSLAMM proved to be a beneficial resource to assess green space performance; however, the sensitivity of the infiltration parameter suggests that field measurements of this characteristic may be needed to achieve accurate results.

scholarly journals Impact of COVID-19 pandemic on training of pharmacy residents and fellows: Results from a national survey of postgraduate pharmacy trainees

2021 ◽  
Author(s):  
W Justin Moore ◽  
Andrew Webb ◽  
Taylor Morrisette ◽  
Louisa K Sullivan ◽  
Sara Alosaimy ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Quality Of Experience ◽  
The United States ◽  
Direct Patient Care ◽  
Training Experience ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Perceived Impacts ◽  
Minor Improvement

Abstract Purpose The coronavirus disease 2019 (COVID-19) pandemic has impacted the activities of healthcare workers, including postgraduate pharmacy trainees. Quality training experiences must be maintained to produce competent pharmacy practitioners and maintain program standards. Methods A cross-sectional survey of postgraduate pharmacy trainees in the United States was conducted to evaluate training experience changes and assess perceived impacts on residents and fellows following the COVID-19 pandemic’s onset. Results From June 4 through June 22, 2020, 511 pharmacy trainees in 46 states completed the survey. Participants’ median age was 26 (interquartile range [IQR], 25-28) years, with included responses from postgraduate year 1 residents (54% of sample), postgraduate year 2 residents (40%), and postgraduate fellows (6%). Compared to experiences prior to the onset of the COVID-19 pandemic, fewer trainees conducted direct patient care (38.5% vs 91.4%, P < 0.001), more worked from home (31.7% vs 1.6%, P < 0.001), and less time was spent with preceptors per day (2 [IQR, 2-6] hours vs 4 [IQR, 1-4] hours, P < 0.001). Sixty-five percent of respondents reported experiencing changes in their training program, 39% reported being asked to work in areas outside of their routine training experience, and 89% stated their training shifted to focus on COVID-19 to some degree. Most respondents perceived either major (9.6%) or minor (52.0%) worsening in quality of experience, with major and minor improvement in quality of experience reported by 5.5% and 8.4% of respondents, respectively. Conclusion Pharmacy resident/fellow experiences were perceived to have been extensively impacted by the COVID-19 pandemic in varying ways. Our findings describe shifts in postgraduate training and may aid in the development of best practices for optimizing trainee experiences in future crises.

State Medical Boards' Perceptions of a Minimum Data Set and Current Practices for Collecting Physician Information

2013 ◽  
Vol 99 (4) ◽  
pp. 40-45 ◽  
Author(s):  
Aaron Young ◽  
Philip Davignon ◽  
Margaret B. Hansen ◽  
Mark A. Eggen
Keyword(s):  
Media Coverage ◽  
The United States ◽  
Minimum Data Set ◽  
Direct Patient Care ◽  
Physician Workforce ◽  
Data Set ◽  
Minimum Data ◽  
State Medical Boards ◽  
The Impact ◽  
Current Practices

ABSTRACT Recent media coverage has focused on the supply of physicians in the United States, especially with the impact of a growing physician shortage and the Affordable Care Act. State medical boards and other entities maintain data on physician licensure and discipline, as well as some biographical data describing their physician populations. However, there are gaps of workforce information in these sources. The Federation of State Medical Boards' (FSMB) Census of Licensed Physicians and the AMA Masterfile, for example, offer valuable information, but they provide a limited picture of the physician workforce. Furthermore, they are unable to shed light on some of the nuances in physician availability, such as how much time physicians spend providing direct patient care. In response to these gaps, policymakers and regulators have in recent years discussed the creation of a physician minimum data set (MDS), which would be gathered periodically and would provide key physician workforce information. While proponents of an MDS believe it would provide benefits to a variety of stakeholders, an effort has not been attempted to determine whether state medical boards think it is important to collect physician workforce data and if they currently collect workforce information from licensed physicians. To learn more, the FSMB sent surveys to the executive directors at state medical boards to determine their perceptions of collecting workforce data and current practices regarding their collection of such data. The purpose of this article is to convey results from this effort. Survey findings indicate that the vast majority of boards view physician workforce information as valuable in the determination of health care needs within their state, and that various boards are already collecting some data elements. Analysis of the data confirms the potential benefits of a physician minimum data set (MDS) and why state medical boards are in a unique position to collect MDS information from physicians.

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