BackgroundThe theory of middle managers’ role in implementing healthcare innovations hypothesized that middle managers influence implementation effectiveness by fulfilling the following four roles: diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. The theory also suggested several activities in which middle managers might engage to fulfill the four roles. The extent to which the theory aligns with middle managers’ experience in practice is unclear. We surveyed middle managers (n = 63) who attended a nursing innovation summit to (1) assess alignment between the theory and middle managers’ experience in practice and (2) elaborate on the theory with examples from middle managers’ experience overseeing innovation implementation in practice.FindingsMiddle managers rated all of the theory’s hypothesized four roles as “extremely important” but ranked diffusing and synthesizing information as the most important and selling innovation implementation as the least important. They reported engaging in several activities that were consistent with the theory’s hypothesized roles and activities such as diffusing information via meetings and training. They also reported engaging in activities not described in the theory such as appraising employee performance.ConclusionsMiddle managers’ experience aligned well with the theory and expanded definitions of the roles and activities that it hypothesized. Future studies should assess the relationship between hypothesized roles and the effectiveness with which innovations are implemented in practice. If evidence supports the theory, the theory should be leveraged to promote the fulfillment of hypothesized roles among middle managers, doing so may promote innovation implementation.

No abstract

In the United States. a debate has existed for decades about whether foreign-trained physicians (known in the US as`international medical graduates' or`IMGs') and US medical graduates (USMGs) have been di erentially distributed such that IMGs were more likely to be found in locales characterized as high in need or medical underservice. This`safety net' hypothesis has been countered by the IMG`surplus exacerbation' argument that IMGs have simply swelled an already abundant supply of physicians without any disproportionate service to areas in need. Through an analysis of the American Medical Association Physician Master®le and the Area Resource File, we classi®ed post-resident IMGs and USMGs into low and high need counties in each of the US states, compared the percentage distributions, and determined whether IMGs were found disproportionately in high need or underserved counties. Using four measures (infant mortality rate, socio-economic status, proportion non-white population, and rural county designation), we show that there were consistently more states having IMG disproportions than USMG disproportions. The magnitude of the di erences was greater for IMGs than for USMGs, and there was a correlation between IMG disproportions and low doctor/100,000 population ratios. These ®ndings are shown to exist simultaneously with two empirical facts: ®rst, not all IMGs were located in high new or underserved counties; second, IMGs were more likely than USMGs to be located in states with a large number of physicians. The juxtaposition of an IMG presence in`safety net' locales and of IMGs' contribution to a physician abundance is discussed within the context of the current debate about a US physician`surplus' and initiatives to reduce the number of IMGs in residency training. #

This study examined health literacy, social support, and their relations to health status and health care use among older adults. The survey design and data were from a project that examined the prevalence of low health literacy among community-dwelling Medicare beneficiaries enrolled in a national managed care organization. Results indicate that compared to the high health literacy group, enrollees with low health literacy were more likely to receive medical information support and health reminder support. However, they were less likely to receive tangible support for their health care needs. In both health literacy groups, medical information support and health reminder support were associated with lower physical health and mental health status. Tangible support was associated with higher physical and mental health status. Health reminder support was associated with more doctor visits and a lower likelihood of hospitalization in the high health literacy group. Implications for reducing the adverse health consequences of low health literacy among older adults are discussed.

Objective. To examine the effects of global budgeting on the distribution of dentists and the use and cost of dental care in Taiwan. Data Sources. (1) Monthly dental claim data from January 1996 to December 2001 for the entire insured population in Taiwan. (2) The 1996–2001 population information for the cities, counties and townships in Taiwan, abstracted from the Taiwan‐Fukien Demographic Fact Book. Study Design. Longitudinal, using the autocorrelation model. Principal Findings. Results indicated decline in dental care utilization, particularly after the implementation of dental global budgeting. With few exceptions, dental global budgeting did not improve the distribution of dental care and dentist supply. Conclusions. The experience of the dental global budget program in Taiwan suggested that dental global budgeting might contain dental care utilization and that several conditions might have to be met in order for the reimbursement system to have effective redistributive impact on dental care and dentist supply.