Administration in ambulatory care.
Deficiencies in management of U.S. Department of Veterans Affairs (USDVA) ambulatory care programs have been documented in the literature and were reaffirmed by conference participants. These represent significant barriers to developing an effective and efficient system of outpatient health care delivery for veterans and to expanding educational opportunities for trainees. Based on impact and feasibility rankings from the symposium, review of the literature, and the personal experiences of USDVA ambulatory care managers, several recommendations emerged: (1) implement a system of matrix management; (2) invest in a leader; (3) develop "user-friendly" management information systems; (4) utilize existing resources efficiently; (5) embrace quality assurance; and (6) improve support from clerical and diagnostic services, nursing, and pharmacy personnel. Although intervention from leadership at the level of the USDVA Central Office will be necessary, many of these recommendations can be adopted by managers at the local facilities. The biggest challenge is to change the attitudes of clinical and support staff whose responsibilities have traditionally been inpatient-oriented.
Nardone
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Oregon Sciences University, Portland.
Webb
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D000553:Ambulatory Care / Q000458:organization & administration*; D006749:Hospital Design and Construction; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D008331:Management Information Systems; D010559:Personnel Management; D011785:Quality Assurance, Health Care; D014481:United States