Preface
Contents
Part I: Human Health: Past, Present and Future
Chapter 1: Health Systems of the World
1.1 Development of a Profile for Service Delivery
1.2 Implications of Shifting Landscape
1.2.1 Health Care Innovation
1.2.2 Health Clusters
1.3 Health Systems
1.3.1 Health care in the USA
1.3.2 Canada
1.4 UK Health Care System
1.5 Health Care in the European Union
1.6 Health Care Systems in Asia
1.6.1 Singapore
1.6.2 China
1.6.3 India
1.7 Health Care System in Australia
1.8 Health Care System in Africa
1.9 Top Health Care Systems
1.9.1 South Korea
1.9.2 Taiwan
1.9.3 Denmark
1.9.4 Austria
1.9.5 Japan
1.9.6 France
1.9.7 Spain, Belgium, and the UK
1.10 Global Health 2035
1.11 Human Health in the Changing World
1.12 The Way Forward
1.12.1 Health Care Systems in Developed Countries
1.13 Global Health
References
Chapter 2: The Future of Health Care Delivery
2.1 Universal Health Coverage
2.2 Trends for Future Health Care
2.3 Emerging Infectious Diseases (EIDs)
2.4 Lifestyle Diseases
2.5 Mental Health
2.6 Changing Health Needs of the People
2.7 Climate Change
2.8 Implications for Academic Health Centers
2.9 Strategies to Reshape the Health Care Industry Landscape
2.10 Artificial Intelligence
2.11 Trends in Hospital Planning and Design
2.12 Community Outreach
2.13 Health Care Delivery
2.14 Preparing Today’s Leaders for Tomorrow’s World
2.15 Future Global Human Resource Trends
2.16 Quality Management
2.17 Health Care in India
2.18 Health Insurance
2.19 Models of Health Care Delivery
2.20 Affordable Health Care: Singapore Experience
2.21 Future Trends
2.22 Artificial Intelligence (Twenty-First Century)
2.22.1 Regrowing Damaged Body Parts
2.22.2 A Pill That Lets You Know You Have Taken It—Smart Pills
2.22.3 AI Can Detect Skin Cancer Better Than a Doctor
2.22.4 Your Phone Will Know If You Are Depressed
2.22.5 Helping the Body’s Immune System Fight Cancer
2.22.6 Medicine That Is Tailored to Fit
2.22.7 Fixing Defective Genes
2.23 Summary
References
Chapter 3: An Epidemiological Perspective for Health Care Management
3.1 Population Characteristics
3.2 Need for Health Care
3.3 Utilization of Health Care Services
3.4 Health Status of Populations Served
3.5 Epidemiologic Concepts and Methods
3.6 Trends in Service Population Size
3.7 Service Population Characteristics
3.8 Understanding the Consequences of Health Problems
3.9 The Relationship Between Health System Characteristics and the Health Status of Populations Served
3.10 Monitoring Health Care Systems
3.11 Modifying Structure and Processes
3.12 Formulation and Evaluation of Public Policy
3.13 Feasibility of Using Epidemiology
References
Chapter 4: Health Policy and Planning
4.1 Health Planning Approaches
4.2 Spiral Model of Planning
4.3 Primary Health Care
4.4 Environmental Policy
4.5 Universal Health Coverage (UHC)
4.6 One Health
4.7 Looking Ahead
References
Chapter 5: Healthcare Finance
5.1 Top 10 Health Care Spenders Spending as Percentage of GDP
5.2 Top 10 Military Spenders
5.3 Health Spending
5.4 Health Insurance
5.4.1 Private Health Insurance
5.4.1.1 The Trends and Strategies
5.5 Financing of Health Care in Developing Countries
5.6 Impact on Health Status
5.7 Cost Awareness
5.8 Control of Healthcare Costs
5.9 Hospital Cost Control
5.9.1 Pre-Admission Certificate (PAC)
5.9.2 Ambulatory Services
5.9.3 Pre-Admission Testing (PAT)
5.9.4 Second Opinion Surgery
5.9.4.1 Deductibles and Coinsurance
5.9.4.2 Short-Stay Maternity Benefits
5.9.4.3 Other Procedures
5.10 The Value Improvement Process
5.10.1 Performance Budget
5.11 Financing Healthcare Facilities
5.12 Alternative Strategies
5.13 Capitation/User Charges
5.14 Improving the Value for Money
5.14.1 Pooled Financing
5.14.2 Evaluation of Effectiveness
5.14.3 Education and Training
5.14.4 Balance of Different Systems
5.15 Innovative Methods of Revenue Generation
5.16 Critical Analysis
References
Chapter 6: Evaluating Health Systems
6.1 Aspects of Health Care to Be Evaluated
6.1.1 Quality
6.1.2 Core Indicators
6.2 The Process of Evaluation
6.2.1 Planning
6.2.2 Implementation
6.2.3 Intervention
6.2.4 Monitoring and Feedback
6.3 Analytic Approaches to Evaluation: An Epidemiologic Perspective
6.3.1 Study Designs for Evaluating Interventions
6.3.1.1 Observational Studies
6.3.1.2 Experimental Studies
6.3.1.3 Prospects of Health Services Evaluation
6.3.2 Health Service Programs
6.4 Monitoring
6.5 Case Studies
6.6 Basic Survey Designs
6.6.1 The Elements of Design
6.6.1.1 Groups, Treatments, Measurements
Group
Achieving True Control Groups
The Non-Equivalent Control Group
Measurement Times
6.6.2 Experimental Designs
6.6.2.1 Features Required of Experimental Designs
6.6.3 Quasi-Experimental Designs
6.6.3.1 The Pretest-Posttest Control Group Design
6.6.3.2 The Solomon Four-Group Design
6.6.3.3 The Posttest-Only Control Group Design
6.6.3.4 Nonexperimental Designs
6.7 Cross-Sectional Studies
6.7.1 After-Only Design
6.7.1.1 Separate Sample Pre-Posttest Design
6.8 Cohort Studies
6.8.1 Cohort Study Designs
6.9 Trend Studies
6.9.1 Equivalent Cohort Design
6.10 Panel Studies
6.10.1 Penal Study Design
6.10.1.1 Meta-Analysis of Evaluation Studies
6.11 Improving the Performance of Health System
References
Chapter 7: Health Care Needs Assessment
7.1 Population Characteristics
7.2 Epidemiologic Concepts and Methods
7.3 Trends in Service Population Size
7.4 Monitoring Health Care Systems
7.5 Modifying Structure and Processes
7.6 Feasibility of Epidemiology
References
Chapter 8: Approaches to Health Care Needs Assessment
8.1 Health Care Needs Assessment
8.2 Concepts of Needs
8.3 Baseline Services
8.4 Individual Needs and Population Needs
8.5 Need, Supply, and Demand
8.6 Approaches to Needs Assessment
8.6.1 Comparative Approach to Needs Assessment
8.6.2 Corporate Approach to Needs Assessment
8.6.3 The Epidemiological Approach to Needs Assessment
8.6.4 Statement of the Problem
8.6.5 Subcategories
8.6.6 Prevalence and Incidence
8.6.7 Service Availability
8.6.8 Effectiveness and Cost-Effectiveness of Services
8.6.9 Models of Care
8.6.10 Outcomes, Targets, Information, and Research
8.7 Summary
References
Chapter 9: Public–Private Partnership
9.1 Dimensions of Partnership
9.2 Synergistic Model of Public–Private Partnership
9.3 Service Contract
9.4 Performance-Based Management Contract
9.4.1 Build-Operate-Transfer (BOT)
9.5 Public–Private Partnership in India’s Health Sector
References
Chapter 10: Evidence-Based Medicine and Health Care
10.1 Evidence-Based Practice
10.2 Evidence-Based Practice
10.3 The PICO Framework
10.4 Systematic Reviews/Meta-Analysis
10.5 Clinical Evidence
10.6 Unfiltered Resources
10.7 Clinical Key and Evidence
10.8 EBM and Librarians
10.9 Randomized Controlled Trials (RCT)
10.10 Canadian Context
10.11 Future of EBM Research
References
Chapter 11: Complementary and Alternative Health Care and Medical Practice
11.1 Whole Medical System
11.2 Types of Complementary and Alternative Medicine
11.3 Mind–Body Therapies
11.3.1 Patterns of Use
11.3.2 Fields of Practice
11.3.3 Existing Evidence
11.4 Other Modalities
11.5 Retrospect and Prospect
11.6 Manipulative and Body-Based Practices
11.6.1 Energy Healing
References
Part II: Hospital Management: Principles and Practice
Chapter 12: Modern Techniques in Health Care Management
12.1 The Feedback Loop
12.1.1 Feedback Loop Modified for Demand
12.2 Time Series Analysis
12.2.1 Approaches to Forecasting
12.3 Value Analysis
12.3.1 Economic Analysis
12.4 Queuing Theory
12.5 PERT and CPM
12.5.1 Gantt Chart
12.5.2 Milestone Chart
12.5.3 Flow Process Chart
12.5.4 Pareto Chart
12.6 Statistical Quality Control (SQC)
12.7 Operations Research/Work Study
12.7.1 Procedure
12.7.2 The Method to Be Followed
12.8 Cost Analysis
12.8.1 Importance and Use of Cost Analysis
12.8.2 Definition of Various Terms
12.9 Management by Objectives (MBO)
12.10 Quality Circles
12.10.1 Objectives
12.10.2 Process
12.11 Maps
12.11.1 Units of Analysis
12.12 Skills of a Manager
12.12.1 Theory of Constraints: Transforming Ideas
12.12.2 Applications in Health Care
12.12.3 Emerging Perspectives and Future Trends
12.12.4 Health Care Transformation
12.13 Health Care Marketing
12.13.1 Marketing
12.13.2 Looking Ahead
References
Chapter 13: Fundamentals of Administrative Functions
13.1 Functions of an Administrator
13.1.1 Elements of Management
13.1.2 Planning
13.1.3 Organizing
13.1.4 Staffing
13.1.5 Directing
13.1.6 Controlling
13.1.7 Innovating
13.1.8 Representing (to the Public)
13.2 Levels of Management
13.2.1 Upper-Level Management
13.2.2 Middle-Level Management
13.2.3 Lower-Level Management
13.2.3.1 Line-Staff Relationships
A Line Position
A Staff Position
13.3 Planning
13.3.1 Importance of Planning
13.3.1.1 Steps in Planning Process
13.3.2 Important Aspects of Planning Process
13.4 Planning in Action
13.4.1 The Strategic Planning Process
13.4.2 Developing a Strategic Plan
13.4.3 Setting Effective Objectives
13.4.4 Management by Objectives (MBO)
13.4.5 Forecasting
13.5 Organizing
13.5.1 Systems Theory
13.5.2 Characteristics of Systems
13.5.2.1 Organizational Charts
13.5.2.2 Organizational Growth
13.6 Innovation
13.6.1 Organizational Growth
13.7 Directing
13.7.1 Policy Making
13.7.2 Decision-Making
13.8 Leadership
13.8.1 Bases of Power and Influence
13.9 Leadership Styles
13.9.1 The Leader Dimension
13.9.1.1 Theory X and Theory Y
13.9.1.2 Continuum of Leadership Behavior
13.10 Leadership Behavior Styles
13.10.1 Blake and Mouton’s Managerial Grid
13.10.2 Participative Leadership
13.10.3 Leadership and the Situation
13.10.4 Situational Leadership Theory and the Tri-Dimensional Model
13.10.5 The Contingency Model
13.10.6 Diagnosing the Situation
13.10.7 Building a Team
13.10.8 Leadership Effectiveness
13.10.9 Democratic Leadership
13.10.9.1 How Functional Is It?
13.10.10 Leadership Dilemma
13.10.11 Choosing a Leadership Style
13.10.12 Deciding How to Lead
13.10.13 Leadership Skill Requirements
13.10.13.1 Top Leadership Skills
13.10.13.2 Characteristics of the Effective Leader
13.10.14 Charismatic Leadership
13.10.14.1 Day-to-Day Leadership Requirements
13.10.14.2 Evidence-Based Management
13.10.15 Moral and Social Justification of the Facility
13.10.15.1 Administrative Leadership
13.11 Management By Exception
13.12 Innovating
13.13 Quality Decision-Making
13.14 Artificial Intelligence
13.14.1 Decision Styles
13.14.1.1 The Decision-Making Process
Steps in Decision-Making
Identifying the Central Problem
Developing Alternatives
13.14.1.2 Creativity and Decision- Making Alternatives
13.14.1.3 Using Groups and Committees for Developing Alternatives
13.14.1.4 What the Manager Can Do
13.15 Techniques for Analyzing Alternatives
13.15.1 Capital Budgeting Techniques
13.15.2 Break-Even Analysis
13.15.3 Management Science Techniques
13.15.3.1 Making the Decision
Fitting Decision-Making to the Task
Judgment, Intuition, Creativity
13.15.4 Guidelines for Improved Decision Making
13.15.4.1 Marshall the Facts
13.15.4.2 Consult Your Feelings
13.15.4.3 Make Sure the Timing Is Right
13.15.4.4 Don’t Overstress the “Finality” of Your Decision
13.15.4.5 Talk It Over
13.15.4.6 Check Your Assumptions
13.15.4.7 Analyze the Problem With an Open Mind
Know Yourself
13.16 Meta-Leadership
References
Chapter 14: Strategic Planning
14.1 Epidemiologic Basis of Strategic Planning
14.2 The Theoretical Basis for Strategic Planning
14.3 The Strategic Planning Process
14.3.1 Step 1
14.3.2 Step 2
14.3.3 Step 3
14.3.3.1 Task A: Market Analysis
14.3.3.2 Task B: Assessment of Forces in the External Environment
14.3.3.3 Task C: Competitive Analysis
14.3.3.4 Task D: Internal Organizational Audit
14.3.3.5 Task E: Quality Audit
14.3.4 Step 4
14.3.5 Step 5
14.3.6 Step 6
14.4 Data Resources for Strategic Planning
14.5 Tools to Facilitate Strategic Planning
14.6 Applicability of the Strategic Planning Process
14.7 The Format and Content of the Strategic Plan
14.8 Strategic Planning for the Health Care Facility
References
Chapter 15: Procurement Management in Health Care Systems
15.1 A Good Purchasing System
15.1.1 Fundamentals of Purchasing
15.2 Purchasing Systems
15.3 Group Purchasing
15.3.1 Types of Purchasing Groups
15.3.1.1 Independent Groups
15.3.1.2 System-Based Groups
15.3.2 Alliance or Association-Based Groups
15.3.3 Advantages of Group Purchasing
15.3.4 Disadvantages of Group Purchasing
15.3.5 Strategies for Group Success
15.4 Principles of Purchasing
15.4.1 Right Quantity
15.4.2 Right Quality
15.4.3 Right Quality
15.4.4 Right Price
15.4.5 Value Analysis
15.4.6 Right Time (Delivery)
15.4.7 Right Sources
15.5 Purchase Through DGS&D
15.6 Stores Management
15.7 Type of Hospital Stores
15.7.1 Planning of Hospital Stores
15.7.2 Medical and Drug Stores
15.7.3 Surgical Stores
15.7.4 General Stores
15.7.5 Linen Stores
15.7.6 Stationery Stores
15.7.7 Dietary Stores
15.7.8 Engineering and Maintenance Stores
15.7.9 Indenting of Stores
15.7.10 Annual Indents
15.7.11 Supplementary Indents
15.7.12 Emergent Indents
15.7.13 Prerequisites for Indenting
15.7.14 Procurement
15.7.14.1 Registration of Firms
15.7.14.2 Banning/Blacklisting of Firms
15.7.15 Banning
15.7.16 Removal
15.7.17 Blacklisting
15.7.18 Recovery of Damages
15.7.19 Procurement of Stores
15.7.19.1 Direct Purchase
15.7.19.2 Receipt, Acceptance, and Opening of Tenders
15.7.19.3 Comparative Statement and Selection
15.7.19.4 Purchase of Proprietary Articles/Drugs
15.7.19.5 Placement of Supply Orders
15.7.19.6 Repeat Supply Orders
15.7.19.7 Inspection of Stores
15.7.19.8 Payment of Bills
15.7.19.9 Stock Verification
15.7.19.10 Obsolescence
15.7.19.11 Condemnation
15.7.19.12 Auction of Stores/Disposal of Surplus
15.7.19.13 How to Prevent Drug Stockouts
15.8 Stores Control
15.8.1 Closed System
15.8.2 Open System
15.8.3 Location of Stores
15.8.4 Layout of Stores
15.8.5 Space Requirement
15.9 Cost Containment
15.10 Strategic Purchasing
15.11 Value Based Purchasing (VBP)
References
Chapter 16: Hospital Information Systems
16.1 Hospital Information System
16.2 Types of HIS
16.3 Best Practices for HIS
16.3.1 Functions of the HIS
16.3.2 Applications of HIS
16.4 Appropriate Design
16.4.1 HIS Design Considerations
16.5 System Development Life Cycle
16.6 Patient Care Information Systems
16.7 Paper Medical Records
16.8 Architecture of HIS
16.9 Scope of HIS
16.10 Organizational Structure
16.11 Benefits of HIS
16.12 Management Information System (MIS)
16.13 Selecting a Hospital Information System
16.14 Hospital Management Information System
16.15 Improved Information Access—Ambulatory Care
16.16 HIS: An Ongoing Journey
16.17 Future Scenario
References
Chapter 17: Medical Records
17.1 Functions of Medical Records Department
17.1.1 Central Admission and Enquiry Office
17.1.2 Out-Patient Section
17.1.3 Central Record Department
17.1.3.1 Assembling
17.2 Quantitative Analysis
17.2.1 Basic Records
17.2.2 Special Records
17.2.3 Deficiency Check
17.2.4 Coding
17.2.5 Indexing
17.2.6 Analysis and Statistics
17.2.7 Reporting
17.2.8 Numbering and Filing
17.2.8.1 Serial Numbering
17.2.8.2 Unit-Number System
17.2.8.3 Serial-Unit Numbering
17.3 Filing System
17.3.1 Decentralized System
17.3.2 Centralized System
17.3.3 Methods of Filing
17.3.3.1 Horizontal Filing
17.3.3.2 Vertical Filing
17.4 Space
17.5 Storage (Retention)
17.6 Ownership and Uses
17.6.1 As a Personal Document
17.6.1.1 Patient
17.6.1.2 Relatives and Friends
17.6.1.3 Press
17.6.1.4 Insurance Companies
17.6.1.5 Police
17.6.1.6 Court of Law
17.6.2 As an Impersonal Document
17.7 Electronic Health Records
References
Chapter 18: Computerized Medical Record Systems
18.1 Medical Record Models
18.2 The Input Process
18.3 The Output Process
18.4 The Storage Process
18.5 The Way Medical Records are Organized
18.6 The Medical Record System
18.7 Minimum Basic Data Set
18.8 A Name is Not Enough
18.8.1 Systematized Nomenclature of Pathology
18.9 Systematized Nomenclature of Medicine
18.9.1 Diagnosis-Related Groups
18.9.2 TNM Classification
18.9.3 Current Procedural Terminology
18.9.4 Read Codes
18.10 Architecture of an Electronic Medical Record System
18.10.1 The Storage Problem
18.10.2 In Search of a Model
18.11 Bibliographic Retrieval Systems
18.11.1 The Information Overload
18.11.2 Online Database Services
18.11.2.1 Medline
18.11.2.2 Embase
18.11.2.3 Emdrugs
18.11.2.4 CD-ROM
18.11.2.5 CD Plus Medline from CD Plus
18.11.2.6 Drug Information Centre from American Society of Pharmacists
18.11.2.7 Excerpta Medica CD: Drugs and Pharmacology from Silver Platter Information Inc.
18.12 Looking Ahead
References
Chapter 19: Nursing Services
19.1 Professionalization
19.2 Changes in the Expectations of Consumer
19.2.1 Nursing Tasks
19.2.2 Role of Nursing Supervisor
19.2.3 Job Responsibilities of Nurses
19.2.4 Nursing Care Requires
19.3 The ICN Code of Ethics for Nurses
19.4 Nursing Practice
19.4.1 Organization of Nursing Service
19.4.2 The Structure and Management of Nursing Services
19.4.3 Staffing
19.5 Factors Affecting Human Resource Planning
19.6 Methods of Human Resource Planning
19.6.1 Normative Methods
19.6.1.1 Indices of Hospital Nurses
19.7 A Model Classification System
19.8 Application to Staffing
19.8.1 How to Calculate Required Nursing Hours
19.8.1.1 How to Calculate Available Staff Hours By Skill Level
19.8.1.2 How to Develop Staffing Tables
19.8.2 Indian Staffing Norms
19.8.3 Norms of Staffing (SIU—Staff Inspection Unit)
19.8.3.1 High Power Committee on Nursing and the Profession (1987–1989)
19.8.4 Community Nursing Services
19.8.5 Management of a Nursing Unit
19.8.6 Physical Facilities
19.9 Organization and Staffing
19.9.1 Nursing Care
19.9.2 Organization
19.9.3 Domestic
19.9.4 Number of Patients
19.9.5 Physical Dependency of Patients
19.9.6 Total Nursing Needs of the Patient
19.9.7 Physical Facilities, Equipment, and Supplies
19.10 Work Allocation
19.10.1 Patterns of Assignment
19.11 Record
19.12 Evaluation
19.12.1 Towards Quality Nursing Care
19.12.2 The Nursing Unit
19.12.2.1 Area
19.12.2.2 Functions
19.12.3 Planning for Total Patient Care
19.12.4 After-Care of Patients
19.12.5 Objectives of Nursing Care
19.12.6 Commonly Encountered Problems
19.12.7 Job Responsibilities of Nursing Staff
19.12.7.1 Indices of Nursing Performance
19.12.8 Standards of Nursing Practice
19.12.9 Curriculum for a New Millennium
19.12.10 Looking Ahead
References
Chapter 20: Health Care Marketing
20.1 Action Plan
20.2 Issues
20.2.1 Using Marketing Principles for Health Care Development
20.2.2 Principal Marketing Activities
20.2.3 Analyzing Opportunities
20.3 Selecting Target Market
20.4 Devising Marketing Strategies
20.4.1 Positioning
20.4.2 Product Development
20.4.3 Maintaining the Product Lifecycle
20.5 Planning Marketing Programs
20.6 Organizing, Implementing, and Controlling
20.7 Working Within a Strategic Framework
20.7.1 Pathways to Using Marketing Principle
20.8 Emerging Perspectives and Future Trends in Health Care Marketing
20.8.1 Health Care Content Marketing
20.9 Build Sophisticated Capabilities
20.10 Measure What Works
20.10.1 Components of a Health Care Marketing Strategy
20.11 Health Care Provider
20.11.1 Challenges of Health Care Marketing
20.11.2 Medical Marketing Trends
20.12 Online Tools for Health Care Marketing
20.12.1 Steps for Establishing Your Health Care Marketing Strategy
20.12.2 Social Media and Health Care Marketing
20.12.3 Health Care Marketing Strategies
20.12.4 Health Care Marketing Initiatives
20.12.5 Developing a Marketing Plan
20.12.6 Activities Regarding Hospital Marketing
20.12.7 Measuring Marketing Campaign Success
20.12.8 Marketing Fundamentals
References
Part III: Management of Organizational Behaviour
Chapter 21: Operations Research
21.1 Constituents of the OR Process
21.2 Techniques of Operations Research
21.3 Quantitative Analysis, Decision Support Systems, and AI
21.3.1 Management Information Systems
21.3.2 Decision Support Systems
21.4 Artificial Intelligence
21.4.1 Benefits of Artificial Intelligence
21.4.2 Use of Expert Systems
21.5 Looking Ahead
References
Chapter 22: Transactional Analysis
22.1 The Parent
22.2 The Child
22.3 The Adult
22.4 Parent Clues
22.4.1 Physical
22.4.2 Verbal
22.5 Child Clues
22.6 Adult Clues
22.6.1 Physical
22.6.2 Verbal
22.7 Crossed Transactions
22.8 Ulterior Transactions
22.9 Duplex Transactions
22.10 Summary
22.11 Looking Ahead
References
Chapter 23: Managing Conflict
23.1 Conflicts and Intergroup Relations
23.1.1 Conflict: Too Much or Too Little?
23.1.2 Conflict Among Groups
23.2 Managing Conflict
23.2.1 Diagnosing the Conflict
23.2.2 How to Deal with Conflict?
23.2.3 Teamwork
23.3 Power Differences
23.4 Societal Differences
23.5 Summary
References
Part IV: Modern Approach to Quality
Chapter 24: Surgical Audit
24.1 The Evolution of Surgical Audit
24.2 The Establishment of Standards
24.3 Economic Audit
24.4 The Grading of Severity of Illness
24.5 Standardized Mortality Rates
24.6 Performance Indicators
24.6.1 Limitations
24.7 The Containment of Costs
24.8 Prevention
24.9 Audit of Outcome
24.10 Guidelines for Audit
24.11 Methods
24.11.1 Adverse Patient Events
24.11.2 Key Indicators
24.11.2.1 Process
24.11.2.2 Outcome
24.11.3 Resource Utilization Indicators
24.11.4 Topic Review
24.11.4.1 General Surgery
24.11.4.2 Cardiothoracic Surgery
24.11.4.3 Urology
24.11.4.4 Neurosurgery
24.11.4.5 Pediatric Surgery
24.11.4.6 Obstetrics and Gynecology
24.11.4.7 Orthopedic Surgery
24.11.4.8 Plastic Surgery
24.11.4.9 Oral and Maxillofacial Surgery
24.11.4.10 Otolaryngology
24.11.4.11 Ophthalmology
24.11.5 Epidemiological Review
24.11.6 National Audit Studies
24.12 Modern Surgical Practice
References
Chapter 25: Total Quality Management
25.1 Focus on Quality
25.2 Working Together
25.3 Legal Perspective
25.4 Defining Quality
25.5 Ethical Standards
25.6 Quality Control Functions
25.7 Managerial Opportunities
25.8 Elements of QA
25.9 Accountability Structures
25.10 Evaluation of QA
25.11 Scope of TQM
25.12 Role of Management
25.13 Implementation
25.14 Looking Ahead
References
Part V: Health Care Reforms
Chapter 26: Professional Regulation, Law, and Ethics
26.1 On Being a Doctor
26.2 A Humane Approach
26.2.1 Technological Complexity
26.2.1.1 Duties of Medical Care
26.3 Disease Prevention and Health Promotion
26.4 Responsibility and Sensitivity
26.4.1 Legal Actions Against Health Care Providers
26.4.2 The Litigation Process
26.5 Clinical Expertise
26.6 Medical Errors
26.6.1 Professional Regulation
26.6.1.1 The Law
26.6.1.2 Rational Self-Interest
26.6.1.3 The Clinical Importance of Trust
26.6.1.4 The Doctor/Patient Relationship
26.7 Medical Decision-Making
26.8 Ethical Principles
26.8.1 Respect for Autonomy
26.8.2 Beneficence
26.8.3 The Nature of Medical Mistakes
26.8.3.1 Clinical Negligence
26.8.4 Breach of Professional Duty
26.8.4.1 Inexperience Is Not Relevant
26.8.4.2 Mistakes Are Not Necessarily to Be Feared
26.8.5 Respect for Autonomy
26.8.5.1 Consent That Is Legally Valid
26.8.5.2 Battery
26.8.5.3 Negligence: Knowledge of Potential Hazards
26.8.5.4 The Appropriate Disclosure Standard for Doctors
26.8.5.5 Implied vs. Express Consent
26.8.5.6 Confidentiality
26.8.5.7 Respecting Confidentiality in Practice
26.8.5.8 When Confidentiality Must or May Be Breached
26.8.5.9 Children
26.8.5.10 Psychiatric Illness
26.8.6 Protect Life and Health
26.8.6.1 Competent Refusal
26.9 Medical Law and Ethics
26.10 Law Classifications
26.11 Contracts
26.12 Malpractice
26.13 Malpractice and Civil Law
26.13.1 Terminating Care of a Patient
26.14 Standard of Care
26.14.1 Documentation
26.14.2 Referrals
26.14.3 Patients and the Legal Documents
26.14.4 Confidentiality Issues
26.15 Confidentiality
26.16 Legal and Ethical Regulations
26.17 Doctor–Patient Relationship
26.17.1 Death and Related Queries
26.17.1.1 Terminal Illness and Palliative Care
26.18 Assisted Reproductive Technology (ART)
26.19 Surrogacy
26.20 Genetic Testing
26.21 Creating Awareness
26.22 Breaking Bad News (BBN)
References
Chapter 27: Scientific Research
27.1 Scientific Research
27.2 Scientific Inquiry
27.2.1 Properties of Scientific Inquiry
27.2.2 Types of Research
27.2.3 The Research Process
27.2.4 Research Methods
27.2.4.1 Quantitative Methods
27.2.4.2 Qualitative Data Sources
27.2.4.3 Designing a Study (RD)
27.3 Methodology
27.3.1 Definition of Methodology
27.3.2 Characteristics
27.3.2.1 Results
27.4 The Discussion
27.5 Biomedical Research
27.6 Types of Research Studies
27.7 Qualitative Research
27.8 Quantitative Research
27.9 Research Methods
27.9.1 Validity
27.10 Populations and Samples
27.10.1 Why Sample?
27.11 Types of Sampling Procedures
27.12 Types of Questions
27.12.1 Variables
27.13 Hypotheses
27.14 Structure of Research
27.14.1 Validity
27.15 Ethical Issues
27.15.1 The Literature Review
27.16 Concept Mapping
27.16.1 Sampling
27.17 Sampling
27.17.1 Probability Sampling
27.17.1.1 Simple Random Sampling
27.17.1.2 Stratified Random Sampling
27.17.1.3 Systematic Random Sampling
27.17.1.4 Cluster Random Sampling
27.17.1.5 Multistage Sampling
27.17.1.6 Nonprobability Sampling
27.17.2 Measurement Validity Types
27.17.2.1 Construct Validity
27.17.2.2 Criterion-Related Validity
27.17.3 Convergent and Discriminant Validity
27.17.3.1 Convergent Validity
27.17.3.2 Discriminant Validity
27.18 Reliability
27.18.1 Types of Reliability
27.18.1.1 Levels of Measurement
27.18.2 Survey Research
27.19 Telephonic
27.19.1 Interviews
27.19.2 Scaling
27.20 Experimental Analysis
27.21 The T-Test
27.22 How to Write Research Work
27.22.1 Introduction
27.22.2 Methods
27.22.2.1 Sample Section
27.22.3 Measurement Section
27.23 Results
27.24 The Parts of a Research Paper
References
Part VI: Researches for Health
Chapter 28: Technology Assessment in Health Care
28.1 Looking Ahead
Reference
Chapter 29: Health Statistics
29.1 Main Uses
29.2 Vital Statistics and Measurement in Public Health
29.2.1 Vital Statistics
29.2.2 Sources of Statistical Data
29.2.3 Problems of Measurement
29.2.3.1 Population Size
29.2.3.2 Inter-censal Events
29.2.4 Mortality Rates
29.2.4.1 Deriving a Rate
29.2.4.2 Seasonal Variation in Mortality: Quarterly Rates
29.2.4.3 Mortality Rates Around the Time of Birth
29.2.4.4 Secular Trends in Annual Mortality Rates
29.2.5 Specific Rates
29.2.5.1 Age- and Sex-Specific Mortality Rates
29.2.5.2 Mortality by Area, by Occupation, and by Social Class
29.2.5.3 Standardization
29.2.5.4 Standardized Mortality Ratio (SMR)
29.2.5.5 Interpreting the SMR
29.3 Descriptive Statistics and Confidence Intervals
29.3.1 Population
29.3.2 Representative Sample
29.3.3 A Statistic
29.3.4 A Variable
29.3.5 Diagrammatic Representation of Data
29.3.5.1 Histogram
29.3.5.2 Bar Chart
29.3.5.3 Pie Chart
29.3.5.4 Line Graph
29.3.5.5 Scatter Diagram
29.3.6 Frequency Distribution
29.3.7 Characteristics of Frequency Distributions
29.3.8 Measures of Central Tendency
29.3.9 Measures of Dispersion
29.3.10 Unimodal Distributions (Symmetrical and Skewed)
29.3.11 Bimodal Distributions
29.3.12 Rectangular or Uniform Distributions
29.3.13 Normal or Gaussian Distribution
29.3.13.1 Properties of the Normal Distribution (Fig. 29.11)
29.3.14 Sampling Variation
29.3.15 Random Sampling
29.3.15.1 Properties of Random Sampling
29.3.16 Sampling from Normal (Gaussian) Distributions
29.3.17 Sampling from Non-normal Distribution
29.3.18 Sample Size and Standard Error
29.3.19 Confidence Interval for an Unknown Mean
29.3.20 Two Groups of Paired Observations
29.3.21 Confidence Interval for the Mean of a Set of Differences
29.3.22 Confidence Intervals and Reference Ranges
29.4 Probability and Hypothesis Testing
29.5 Probability
29.5.1 Properties of Probability
29.5.1.1 Range of Values of Probability
29.5.1.2 Combining Probabilities of Mutually Exclusive Events
29.5.1.3 Combining Probabilities of Independent Events
29.5.2 The Probability Basis of Hypothesis Testing
29.5.3 Null and Alternative Hypothesis
29.5.4 Interpreting the p-Value
29.5.5 The Sign Test: A Prototype Hypothesis Test
29.5.5.1 Null Hypothesis, H0
29.5.5.2 Alternative Hypothesis, H1
29.5.6 Generalizing the Sign Test
29.5.6.1 The Influence of Sample Size
29.5.6.2 A Less-than-Unanimous Verdict
29.5.7 The Paired p-Test
29.5.8 Hypothesis Testing or Setting Confidence Intervals
29.6 Comparison of Means
29.6.1 Paired Study for Serial Changes
29.6.2 Deficiencies of Before and After Comparisons
29.6.2.1 Period Effects
29.6.2.2 Placebo Effects
29.6.2.3 Regression Towards the Mean
29.6.3 Valid Assessment of Treatment Efficacy
29.6.3.1 Controlled Trials
29.6.3.2 Random Allocation
29.6.3.3 Blind Recruitment
29.6.3.4 Intention-to-Treat Analysis
29.6.3.5 Blind Assessment
29.6.4 Comparison of Independent Groups: Two-Sample (Unpaired) t-Test
29.6.5 Interpreting Statistical Significance
29.6.6 Interpreting a Not Statistically Significant Result
29.7 Proportions and Their Comparison
29.7.1 Precision of a Proportion
29.7.2 Standard Error of a Proportion
29.7.3 Confidence Interval for a Proportion
29.7.4 Limitations of the Simple Method
29.7.5 Confidence Interval for the Difference Between Two Proportions
29.7.6 The Chi-Square (X2) Hypothesis Test to Compare Two Proportions
29.7.7 Individually Paired Samples: Mcnemar Test
29.7.8 A Summary of the Properties of the X2 Test
References
Chapter 30: Research and Development
30.1 The Wide Scope of Health Services Research
30.1.1 Effectiveness
30.1.2 Efficiency
30.1.3 Acceptability and Public/Patient Perceptions
30.1.4 Health Needs Assessment
30.1.5 Implementation and Technology Transfer
30.1.6 Health Care Resourcing, Organization, and Policy
30.1.7 Different Levels of Analysis
30.2 Methodological Research to Underpin HSR
30.2.1 Randomized Controlled Trials (RCTs)
30.2.1.1 Generalizability
30.2.2 Enhancing Relevance of Practice
30.2.3 Patient Perspectives
30.2.4 Psychological Approaches
30.2.5 Meta-analyses
30.2.6 The Scientific Basis for Systematic Overviews
30.2.7 Systematic Overviews and Clinical Practice
30.2.8 Observational Methods
30.2.8.1 The Validity of Non-RCT
30.2.8.2 The Development of Measures of Case-Mix
30.2.8.3 Cross-Design Synthesis
30.3 Quantitative and Qualitative Assessments of Outcome
30.3.1 Questionnaires
30.3.2 Qualitative Research Methods
30.4 Health Needs Assessment
30.5 Economic Evaluation
30.5.1
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