The effect of new public management on intensive care unit staff
The NHS is largely dependent on two groups of professionals – medics and nurses. Recent government changes support the development of a central role for management. The impact of these changes on the roles and relationships of those working in the NHS must be understood in light of the structures already in place within it. Medical dominance in healthcare decision‐making, nursing power emanating from the strength of the medical‐nursing relationship and the hierarchies within and between the two professions all affect and are affected by recent management changes. In intensive care a key feature of the context, insularity, had already significantly modified these structures prior to recent reforms. This paper starts by discussing and contrasting the response of medics and nurses to these changes before highlighting the differences in the way these changes have impacted on staff in intensive care. Analysis is based on data from an observational study of the formation of a new directorate and interviews with senior nurses, medics and managers in intensive care.
I mötet mellan modern management och professionell praktik. Ny organisering möter sjuksköterskeprofessionen
The Swedish public sector is characterised by comprehensive organisational changes, often discussed in terms of New Public Management (NPM). NPM implies a transfer of management ideas from the priv ...
Study on essential drug use status and its influencing factors among cerebral infarction inpatients in county level hospitals of Anhui Province, China
Background and purpose Drug costs is one of the main components of hospitalization expenditure for cerebral infarction inpatients. In China, the National Essential Medicine System (NEMS) was created to relieve the heavy drug-cost burden for patients. The objective of this study was to investigate essential drug-use status and its influencing factors among cerebral infarction inpatients in county-level hospitals of Anhui province, China. Methods Three county-level hospitals were selected through a multi-stage cluster random sampling method. The hospitalization cost data of cerebral infarction inpatients in the three hospitals were extracted from the Anhui provincial information platform of the New Rural Cooperative Insurance System (NCMS), and whether the proportion of essential drug cost in the total drug cost reached the median value of 33.05% which was set as the evaluation index for essential drug-use status. Questionnaires for hospitals and physicians were designed and given to them to assess influencing factors. Results We retrieved the cost data of 2,189 inpatients from the NCMS platform and investigated 51 corresponding physicians in total. The drug costs accounted for 52.6% of the total hospitalization cost, and essential drug costs alone accounted for 37.0% of the total drug costs. The essential drug-cost proportion was high among physicians with a higher recognition degree on NEMS, older age, lower final academic degree, longer work experience and lower professional title. Married physicians and those with tight organizational affiliation also prescribed more essential drugs. Conclusions Increasing the proportion of essential drugs was an effective way to reduce the disease burden for cerebral infarction patients. Perfecting the NEMS, increasing government investment, reinforcing education and propaganda, and formulating relevant incentive and restrictive mechanisms were all effective ways to promote and increase the number of essential drug prescriptions written by physicians.