What is cost management?

A qualitative case study approach was used to examine four nursing homes. Extreme case examples-high- andlow-performing nursing homes-were purposefully selected. More than 100 hr of observation, 70 formal interviews, numerous informal interviews, and document review were the primary data collection methods.

Findings:

Using select complexity science principles added richness to the analysis, highlighting the stark contrast between the high- andlow-performing nursing homes. Leaders in the high-performing homes behaved congruently with the nursing home's stated and lived mission by fostering connectivity among staff, ample information flow, and the use of cognitive diversity. In contrast, leadership in low-performing homes behaved disharmoniously with the stated mission, which confused and eroded trust and relationships among staff members, contributed to poor communication, and fostered role isolation and discontinuity in resident care.

Practice Implications:

The study offers insights into the importance of mission- and values-based leadership behaviors, suggesting that an overuse of mechanistic, linear command-and-control approaches to improving care, such as punitive measures to insist on regulatory compliance, will do little to ultimately improve care. Rather, relationship-centered leadership that embraces comanagement and mutual shaping of resident care complements doing the right thing for residents from a values-based shared experience. Examples of practice implications include developing a strong, coherent organizational mission; having fewer, more flexible rules to foster creativity; and allowing lateral decision making.

Question 1

Dear authors, why are gastric ulcers more common along the lesser

curve, near the pylorus of the stomach?

Question 2

What is the best time of day to administer omeprazole, and why?

Question 3

Is it safe to use the drugs omeprazole and ranitidine during pregnancy?

Question 4

Are non-steroidal anti-inflammatory drugs harmful to the stomach when

taken parenterally, for example by intravenous or intramuscular routes?

Question 5

Is it recommended to give a young patient, diagnosed endoscopically to

have mild reflux oesophagitis, life-long proton pump inhibitors (PPIs) to

prevent the development of Barrett's oesophagitis?

Question 6

Is it safe to give a patient with reflux oesophagitis who is on proton

pump inhibitors (PPIs) for treatment of acid suppression, aspirin in

antiplatelet doses (75-325 mg per day)?

Question 7

Does a combination of magnesium and aluminium hydroxide salts,

taken as antacid for reflux oesophagitis, have serious long-term adverse

effects? 33

Question 8

In the treatment of reflux oesophagitis with a proton pump inhibitor

(PPI), should the PPI be life long or given for 4-8 weeks, as mentioned by

the drug manufacturers?

Question 9

Would a patient who suffers with reflux oesophagitis as a result of a

hiatus hernia, and who is not responsive to proton pump inhibitors

(PPIs), benefit from a highly selective vagotomy?

Question 10

1. What are the causes of belching and what appropriate drug can be

used?

2. What are the effects of smoking on the gastrointestinal tract and what

is its role in peptic ulcer disease?